941: Are Patients Dying From COVID or With COVID?

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

An immediate cause of death must be listed first in a death certificate form. This is followed by a list of underlying (or predisposing) conditions that were contributory.

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

In COVID-19, similar factors appear to increase the likelihood of a more serious outcome. These include 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. The tally includes thousands of deaths attributed only to COVID-19. A second category of deaths includes those from both pneumonia and COVID-19 and includes thousands more. Then there is a third category of deaths that 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, rather with influenza, which 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 mean the same, but the statistics change.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA