On Saturday, The Indian Express reported that the Director of National Institute of Cholera and Enteric Diseases, Kolkata, Shanta Dutta had called into question West Bengal’s decision to set up a committee to certify Covid-19 deaths. In an interview to Express, Dutta said that it is the treating physician who should decide if a patient with Covid-19 has died due to it.
How then should Covid-19 deaths be certified, and why is this important?
It is important that the deaths due to Covid-19 are accurately attributed and recorded since it is a part of mortality surveillance and provides significant information about how the disease is progressing in the population. On Friday, China revised the death toll in Wuhan city, increasing it by 50 per cent.
Health authorities across the world should ensure that the cause and circumstances of the death of Covid-19 patients are up to date and accurate. The US Centers for Disease Control and Prevention (CDC) maintains that appropriate completion of death certificates helps in yielding accurate and reliable data for use in epidemiological analysis and public health reporting.
To determine if Covid-19 played a role in a person’s death, the World Health Organization (WHO) provides regulations under the International Statistical Classification of Diseases and Related Health Problems (ICD) that ideally should be followed.
These help to provide a framework for determining the single underlying cause of death for recording data and choosing the most appropriate cause of death from the several possible diagnoses that may be mentioned on a patient’s death certificate. As per the ICD guidelines, coronavirus deaths are identified using the ICD-10 code U07.1.
According to the WHO, death due to Covid-19 is defined as death resulting from a “clinically compatible” illness in a probable or confirmed case of Covid-19, “unless there is a clear alternative cause of death that cannot be related” to the disease (for instance trauma). Significantly, to report the cause of death as Covid-19 there should be no complete recovery period between illness and death.
Further, death due to Covid-19 should not be attributed to another disease, such as cancer. It should be counted independently of preexisting conditions that are suspected of triggering a severe course of Covid-19.
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In the death certificates of Covid-19 patients, the WHO has advised that the causal sequence leading to death be specified. For instance, in cases where Covid-19 causes pneumonia and fatal respiratory distress, both of these should be included as causes of death along with Covid-19, which will be the underlying cause of death.
“Certifiers should include as much detail as possible based on their knowledge of the case, as from medical records, or about laboratory testing,” WHO has said.
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In case the patient had existing comorbidities such as hypertension, diabetes, heart disease, etc, then it should be mentioned in the second part of the death certificate.
When Covid-19 has been identified through laboratory testing, the code U07.1 should be used, irrespective of the severity of clinical signs or symptoms. In case Covid-19 has been diagnosed clinically or epidemiologically, but laboratory testing is inconclusive or not available, the code U07.2 should be used.