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Are Patients Dying ‘From’ COVID or ‘With’ COVID?

Dr K K Aggarwal, President CMAAO

Death certificates are supposed to be completed by the attending physician, who is expected to know the most about the patient’s medical conditions but in a hospital setting, often the physician who pronounces death may never have seen the patient before.

The death certificate form requires that an immediate cause of death be listed first. This is followed by a list of underlying (also referred to as predisposing) conditions that were contributory.

In influenza for example a range of predisposing factors that could increase the risk for a serious complication from influenza, including death include an age of 65 years or older, pregnancy, chronic lung disease, heart disease, diabetes, and cancer.

In COVID-19 similar factors seem to predispose to a more serious outcome: older age, chronic lung disease, serious heart conditions, being immunocompromised, and living in a long-term care facility.

The US CDC website reports a provisional COVID-19 death count. This tally includes thousands of deaths attributed solely to COVID-19. A second category of deaths from both pneumonia and COVID-19 includes thousands more persons. A third category of deaths lists three causes: pneumonia, influenza, and COVID-19. There are separate categories for deaths due to pneumonia or influenza alone.

Most patients are not dying from influenza but rather with influenza that is comorbid with something else lethal.In India the covid deaths are counted if the primary cause of death is written as COVID 19 and not as the underlying cause

Imagine the attending physician may write the same situation Immediate cause of death: Uncontrolled diabetes with ketoacidosis Underlying cause: Covid 19 Or   Immediate cause of death:  Covid 19 Underlying cause: Uncontrolled diabetes with ketoacidosis Both means the same but the statistics changes