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What is a Covid 19 death?

Why is “Covid-19 death” different from a death caused by Covid 19?

We constantly hear in the news phrases like “Covid has already killed X number of people in a given country” or “X number of people have died due to the virus”. But do the numbers called “deaths by Covid” mean cases of deaths definitely caused by the virus?

Not necessarily. There are several points that need to be considered.

The WHO has decided to make the disease compulsory to register and has issued guidelines for certification and classification (coding) of covid-19 as cause of death.

“…a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma).”

These guidelines include, in addition to confirmed cases of the disease, probable or suspected cases (without confirmation by laboratory test).

“Covid 19 death” includes:Death was caused by Covid 19?

Confirmed (laboratory)

Virus caused or was the main cause of deathYes
Viruses contribute (secondary factor) In part (not the main one)
Viruses did not contributeNo

Not confirmed (laboratory)

Probable or suspected causeYes
Probable or suspected causeNo

WHO

Even these guidelines seem to be followed differently, and sometimes even contradictory – some being more inclusive, others less, even within the same country and varying in time.

For example, in England the Covid death registration included those who died after a positive test, even if that death occurred at any time after the test (for example, three months later), and regardless of the cause of death.

In August, the procedure changed and they started counting the deaths that occurred until 28 days after the positive test. In the previous week, with the data available (July 18-24), the numbers would drop retrospectively from 442 to 111. The overall reduction was 12%.

In Portugal, Graça Freitas, general director of Health, has clarified some points about the scope of the Covid deaths.  In this press conference on April 18 she said:

“For example, someone who is very bad, with a neoplastic disease. Even if he probably dies of this disease, if he is infected by Covid we register the death as an infection by Covid”.

In other countries such as the US this seems to be the case as well. For example, Ngozi Ezike, director of Illinois Public Health, says:

“Technically even if you died of a clear alternate cause, but you had COVID at the same time, it’s still listed as a COVID death.”

On the other hand, the fact that there are deaths attributed to Covid without laboratory confirmation is not usually mentioned. Its percentage is largely unknown because, apart from a few exceptions, this is not usually published.

Cases, hospitalizations and deaths (New York City)

NYC Department of Health and Mental Hygiene, Covid 19 Data

Many doubts still exist as to how Covid deaths are being recorded in various parts of the world. Thus, it is not possible at this moment to have an idea of the number of deaths that would be attributed to Covid-19 if “normal” procedures were used for other diseases.

However, one thing is certain, the deaths announced as “Deaths by Covid- 19” are not the same thing as deaths caused by Covid- 19.

Covid-19 – WHO guidelines for certification of causes of death and codification

References

Coronavirus: Why are international comparisons difficult? By Chris Morris & Anthony Reuben BBC Reality Check, 17 June 2020

Coronavirus: England death count review reduces UK toll by 5,000. BBC NEWS, Health. 12, August 2020

Diretrizes internacionais para a certificação e classificação (codificação) da Covid-19 como causa de morte- OMS. who.int/classifications/icd/Guidelines_Cause_of_Death_COVID-19-20200420-PT_Apr_24.pdf?ua=1

NYC- Health: Covid- COVID-19: Covid-19. Data

NYC- Health: Covid- COVID-19: Covid-19. About

NYC- Health: COVID-19: Datawebpage- Download case data and technical notes on Github- coronavirus-data/deaths/deaths-by-underlying-conditions.csv

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