Dr. Gaud and the Minister of Health, Dr. Jagutpal, during the last few press conferences of the National Communication Committee (NCC) on COVID-19, announced the deaths of COVID-19 patients while maintaining that some of the deaths are not attributed to the COVID-19 disease itself. How come?
Last year, during similar press conferences, Dr. Gujadhur clearly explained to Mauritians and cautioned us all how existing comorbidities and COVID-19 can be fatal. The total number of deaths attributed to COVID-19 last year is 10.
However, this year, since 5 March, the NCC has informed us of six deaths, out of which they have attributed two to be related to the COVID-19 disease and the other four are non-COVID-19 deaths. The reason given by the NCC is that the World Health Organization has issued guidelines on how to certify COVID-19 related deaths.
This is not enough to stop the many questions of Mauritians. It was unclear to me as well. Therefore, I searched for the WHO Guidelines. The document I found dates April 2020 but these guidelines are only being mentioned by the NCC now.
WHO Guideline for classification of COVID-19 as cause of death
The WHO guideline mentions that a death due to COVID-19 is defined for surveillance purposes as 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).
It also states that a death due to COVID-19 may not be attributed to another disease (e.g cancer) and should be counted independently of preexisting conditions that are suspected of triggering a severe course of COVID-19.
The document shows a few medical certificate examples to makes things clearer to understand.
The above example shows that the patient had existing comorbidities like coronary artery disease, type 2 diabetes and chronic obstructive pulmonary disease. The cause of death is mentioned as acute respiratory distress syndrome, pneumonia and suspected COVID-19.
The document explains when to use the terms Suspected COVID-19, Probable COVID-19 and COVID-19 as cause of death.
As per the WHO guideline, COVID-19 should be mentioned in part 1 on the medical certificate as cause of death and the other diseases should be mentioned in part 2. The document provides several such examples.
It also highlights what kind of death can't be attributed to COVID-19. One example is obvious, if a COVID-19 patient dies of an accident, that death can't be attributed to the COVID-19 disease itself.
In another example, the document cites myocardial infarction which is the medical term for heart attack. In this case, COVID-19 is mentioned in part 2 of the certificate and declared as a NOT COVID-19 death.
I leave it to the medical community to debate further on the topic, whether the authorities are following the guidelines right or wrong. I must admit though that I miss the layman explanation of Dr. V. Gujadhur.
Note that this blog post is NOT an expert opinion on medical practices. Please consult a physician to obtain a more proper, detailed and accurate opinion on the COVID-19 cause of death.
This blog post only intends to express the confusion I found when listening to the NCC press conference and cross-checking information from the World Health Organization.