IThey point out in particular that death certificates do not always mention that COVID-19 was the cause of the person’s death.
For example, Dr Nathan Stall, a geriatrician at Sinai Health in Toronto, says the data only involves those who have tested positive for COVID-19.
Dr Stall believes unknown victims of COVID-19 are not part of the death toll because people are not tested after they die.
A Statistics Canada study, carried out in November, indicated that COVID-19 had been identified as the underlying cause of death in 92% (8,795 of 9,525 deaths) of cases where it was reported on the medical certificate.
In the remaining 8% of cases, cancer, dementia or Alzheimer’s disease, and other chronic diseases such as ischemic heart disease or chronic lung disease were most often considered the underlying cause of death.
“It also speaks to the confusion around how to properly categorize the cause of death,” says Dr Stall.
He regrets that this is not taught much in medical schools. “It’s not something that gets a lot of attention and consideration because doctors often have to be quick to deliver the body to the morgue or funeral home.”
Excess mortality will be the best indicator, says Dr Stall
According to him, the best indicator of the number of deaths caused by the pandemic will be excess mortality, when more deaths than expected during a given period.
Roger Wong, clinical professor of geriatric medicine and associate dean of the Faculty of Medicine at the University of British Columbia, says incomplete or inaccurate data can have public health implications.
“The immediate cause of death can hide the initial causes,” he said.
For example, he mentions, patients who actually died from COVID-19 may have suffered from acute respiratory distress syndrome and pneumonia because the virus affects the lungs.
Thus, the certificate would indicate respiratory distress as the main cause of death. He might add pneumonia and COVID-19. Prof. Wong says it’s important to note what caused the pneumonia.
According to him, scientists and researchers will better understand the effects of COVID-19 in people with long-standing health problems by looking at as many details as possible in death certificates.
Long-standing illnesses or co-morbidities, such as diabetes, heart disease or kidney disease, also complicate the way deaths are recorded, Professor Wong laments, because these patients are at higher risk of infection.
“COVID-19 should be recorded as an underlying cause of death, not as a concomitant health problem,” he emphasizes.
Dr Stall cites cardiopulmonary arrest as another example of a cause of death whose certificate does not mention COVID-19.
“Everyone dies of cardiopulmonary arrest, because everyone dies when their heart stops beating and the lungs stop breathing. It is not a cause of death. It’s the mechanism of death, ”he says.