MACON, Mo. (KTVI) – A Missouri county is likely undercounting COVID-19 deaths after the local coroner admitted to excluding the virus from death certificates.

Macon County Coroner Brian Hayes told The Kansas City Star he’s refrained from listing COVID as a cause of death on at least half a dozen death certificates.

Macon County’s official COVID death toll has been reduced “from upwards of 30 down to 19” because of Hayes’ actions, the Star reports. That reduced number can be found on the Missouri Department of Health Senior Service’s COVID Dashboard as part of the official tally of COVID deaths.

Missouri is one of five states that doesn’t count probable COVID deaths (i.e. those missing a positive PCR test). At least one state health official told the Star that was a decision made by prior leadership, a reference to former health director Dr. Randall Williams. The process for counting a COVID death in Missouri can take up to five weeks in some cases, leading to discrepancies in data at the state, local and national levels.

Hayes said he made changes at the request of families because the thought of seeing COVID listed as a cause of death would be too much to handle.

“A lot of families were upset. They didn’t want COVID on the death certificates,” he told the Star. “I won’t lie for them, it’s gotta be true, but I do what pleases the family.”

Hayes said he wouldn’t put COVID on death certificates when another significant factor could be given as the sole cause of death. The coroner cited examples like pneumonia in an elderly person or a grandparent who smoked all their life.

Hayes has served as Macon County coroner—an elected position—for the last 20 years. He’s also a funeral director in the region.