With 48 deaths recorded at the end of April, King County is more than halfway toward the total number of homeless deaths in all of 2016. Officials say illness and opiates are partially to blame for the increasing number.

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Four entries in a King County Medical Examiner’s Office data ledger tell a small part of their stories.

On Jan. 7: A 22-year-old woman died of an apparent opiate overdose near a Northwest Seattle home. That same day, a 35-year-old woman was killed by a combination of carbon monoxide and opiates in the 7900 block of Aurora Avenue. Both deaths were ruled accidental.

Also that day, a 72-year-old man died of prostate cancer at Northwest Hospital and Medical Center.

And then there was Sean Boarman, whose body was found in April in a park in Seattle’s Wallingford neighborhood. The King County Medical Examiner’s Office determined he died from alcohol poisoning. He was 34.

All four were homeless or living without permanent shelter when they died, according to the Medical Examiner’s Office. Recent figures show the numbers of such deaths are trending, and not in the right direction.

With 48 homeless deaths recorded at the end of April, the county is more than halfway toward the total number in all 2016.

The numbers have been moving upward for several years. In 2010 there were 47 homeless deaths, while in each of the past two years the number was 91.

Determining the totals is an inexact art. Around 14,000 people die in King County each year, and the Medical Examiner’s Office investigates just a fraction of them.

To calculate the number of cases where the deceased was homeless at the time of their death, county investigators count people who died while living on the streets or in hotels or emergency shelters for the homeless. The total also includes people whose address could not be verified.

But authorities say it’s probable there are deaths among the county’s homeless that, for various reasons, never appear on the department’s radar.

Even with those caveats, officials say the trend is troubling and potentially indicative of recent increases in the number of homeless across King County.

Fluctuations in the year-to-year totals make it difficult to draw conclusions, said Dr. Jeff Duchin, health officer for Public Health-Seattle and King County. “But as there are more homeless people, it stands to reason we would see more homeless deaths,” he said.

In November 2015, Seattle Mayor Ed Murray and King County Executive Dow Constantine jointly declared a state of emergency over homelessness. Since then, the number of people living outdoors has steadily climbed.

In January 2016, volunteers fanned out across Seattle and King County and counted 4,505 sleeping outside. Including those in homeless shelters and in transitional housing, the total was 10,047. Authorities said that represented a 19 percent increase over 2015.

Nearly 3,000 of the people without shelter were counted in Seattle.

Results from this year’s overnight count are expected to be released Wednesday. Officials expect the totals to increase yet again.

The deaths are a reminder that the problem is spread throughout the county. Thirty-eight deaths occurred in Seattle, including several at hospitals. The remaining 10 were from as far south as Federal Way and as far east as Bellevue.

Of the 48 deaths recorded this year, four have been classified as homicides.

The continuing opiate-abuse crisis and the flu season may also help explain the recent increases, Duchin said. Medical investigators tied six of the 48 deaths so far this year to use of opiates. The department is awaiting toxicology results for several others.

This year’s flu season was especially severe, with 207 flu-related deaths recorded by the state Department of Health as of Feb. 11. The severity of winter and flu season may have added to the vulnerability of people living outdoors without ready access to health care, Duchin said.

Many homeless people live without regular preventive care, including those who are elderly or living outdoors with underlying or chronic conditions such as pneumonia or heart disease, Duchin said. That population is more susceptible to sudden declines in health, he said.

The scope of the problem is hard to quantify, said John Gilvar, manager of the county’s health-care network for the homeless. Through contracted providers and direct services, the county provides periodic health care to thousands of low-income and homeless people each year.

In addition to being more vulnerable to violence and accidents, the homeless population’s lack of stability also makes managing chronic diseases more difficult, Gilvar said.

Since 2013, local programs working to house and shelter the homeless have managed to boost the number of people placed into permanent housing by 52 percent.

But substance and mental-health problems remain one of the biggest obstacles to securing them a spot in local programs, he said.

“Ultimately, we have to find a way to break the cycle,” Gilvar said.

Behind the numbers are the stories of lives that ended under bridges, in parks or at makeshift homeless camps.

In April, a pedestrian found Sean Boarman lying in a park near the Good Shepherd Center in the Wallingford neighborhood. Attempts to revive him at the scene were unsuccessful.

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Police found a letter in his pocket, addressed to him, from someone with the same last name.

Bridget Mance, Boarman’s younger sister, said they grew up as Army brats, their family moving several times before settling in Kansas. She said he moved to Washington around 2006 with hopes of catching on with a crab-boat crew, but then fell out of contact with their family.

“He liked working with his hands,” Mance said last week. “It was him following his dream.”

Court records indicate he’d spent the years before his death working odd jobs, and when not couch-surfing, living on the Seattle streets. He was also hoping to get treatment for an alcohol problem, according to a 2016 arrest report.

A few years ago, Boarman called his sister at work. It was the first time they’d spoken in about a decade. From there, he re-established ties with their parents. There was some talk of them visiting Boarman in Seattle, and of him returning to Kansas, Mance said.

Would he have gone home eventually?

He was a proud person and not the type to ask for help, she said. “I think he wanted to come back, but obviously that didn’t happen.”