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A thread about how COVID-deaths are recorded.
(Full disclosure: I have personally written death certificates, and also overseen and investigated causes of death to countersign them, including COVID death certificates, as many doctors have). /1 https://twitter.com/BBCNews/status/1354003850043289600
(Full disclosure: I have personally written death certificates, and also overseen and investigated causes of death to countersign them, including COVID death certificates, as many doctors have). /1 https://twitter.com/BBCNews/status/1354003850043289600
Broadly speaking there are three measures of COVID deaths.
1) Gov COVID deaths with 28-days of a positive test | https://coronavirus.data.gov.uk/details/deaths
2) The ONS - COVID death certificates weekly | https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/weeklyprovisionalfiguresondeathsregisteredinenglandandwales
3) PHE report Excess deaths | https://fingertips.phe.org.uk/static-reports/mortality-surveillance/excess-mortality-in-england-latest.html
1) Gov COVID deaths with 28-days of a positive test | https://coronavirus.data.gov.uk/details/deaths
2) The ONS - COVID death certificates weekly | https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/weeklyprovisionalfiguresondeathsregisteredinenglandandwales
3) PHE report Excess deaths | https://fingertips.phe.org.uk/static-reports/mortality-surveillance/excess-mortality-in-england-latest.html
-All of the datasets are independent from each other.
Nearly UNIVERSALLY, the number of COVID deaths within a positive test has been the LOWEST of the three, with ONS deaths higher and EXCESS deaths higher still.
Nearly UNIVERSALLY, the number of COVID deaths within a positive test has been the LOWEST of the three, with ONS deaths higher and EXCESS deaths higher still.
-The ONS look at the death certificates.
-When you die, a doctor that PERSONALLY saw you during life must fill in your death certificate, with an accurate diagnosis and cause of death.
-We spend ALOT of time on this, and where there is uncertainty we speak to the coroner.
-When you die, a doctor that PERSONALLY saw you during life must fill in your death certificate, with an accurate diagnosis and cause of death.
-We spend ALOT of time on this, and where there is uncertainty we speak to the coroner.
-Here is an example death certificate:
There are TWO PARTS, under "CAUSE OF DEATH":
1a: We enter the disease or condition DIRECTLY LEADING TO DEATH
2: We enter conditions CONTRIBUTING to the death
We don't, and shouldn't, write anything on here.
There are TWO PARTS, under "CAUSE OF DEATH":
1a: We enter the disease or condition DIRECTLY LEADING TO DEATH
2: We enter conditions CONTRIBUTING to the death
We don't, and shouldn't, write anything on here.
-For cremation we also have to fill in two parts of a cremation form, with a narrative as well as causes & a second independent doctor needs to investigate, agree and sign the Part 2 for a cremation.
-Falsifying or failing our duty to write an accurate certificate is a crime.
-Falsifying or failing our duty to write an accurate certificate is a crime.
-Where there is uncertainty we refer to the coroner for all sorts of things:
- where we have no cause of death and need a postmortem
- if we suspect foul play or accidental or procedural deaths
- and many more....
Summary |
https://www.nlg.nhs.uk/content/uploads/2013/12/Guidelines-to-Doctors-on-Reporting-Deaths-to-the-Coroner.pdf
- where we have no cause of death and need a postmortem
- if we suspect foul play or accidental or procedural deaths
- and many more....
Summary |
https://www.nlg.nhs.uk/content/uploads/2013/12/Guidelines-to-Doctors-on-Reporting-Deaths-to-the-Coroner.pdf
- Families can also dispute the cause of death and refer directly to the coroner if they wish to, they can decide to hold an inquest: https://www.roydswithyking.com/solicitors-for-life/bereavement-guide/concerns-about-the-circumstances-of-a-death/
- Doctors are very much afraid of litigation and coroners inquests. We really don't mess around with this and take it very seriously.
Most workplaces require consultant approval.
So writing "COVID-19" on a death certificate is not a trivial matter at all.
Most workplaces require consultant approval.
So writing "COVID-19" on a death certificate is not a trivial matter at all.
- "COVID-pneumonia" is the proper term for the respiratory failure we see with severe COVID, but there are other causes of death related to COVID: kidney failure, sepsis, cardiac arrest.
-COVID also contributes to death, with 1 in 8 COVID discharges dying within 4 months.
-COVID also contributes to death, with 1 in 8 COVID discharges dying within 4 months.
In essence, COVID is an utter bastard, and if you are properly sick with it will affect your health significantly, regardless of what else happens.
The ONS data higher than the 28-day figure, and this reflects the long-term health problems COVID causes.
The ONS data higher than the 28-day figure, and this reflects the long-term health problems COVID causes.
You can also see the ONS data is LOWER than excess deaths. And the ONS has investigated why: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/analysisofdeathregistrationsnotinvolvingcoronaviruscovid19englandandwales28december2019to1may2020/technicalannex
...and concluded the rise and fall mostly undiagnosed COVID, with a minority of non-COVID death as well (delayed treatment etc)
...and concluded the rise and fall mostly undiagnosed COVID, with a minority of non-COVID death as well (delayed treatment etc)
Just a quick note that excess deaths also show LOWER risk of death in younger patients, mostly due to reduction in RTAs.
There simply hasn't been a detectable increase in excess deaths due to other causes, especially in the young:
There simply hasn't been a detectable increase in excess deaths due to other causes, especially in the young:
The ONS data is inescapable & the excess data continues to be even worse.
Please take it seriously. Remember each of those deaths was a real person with a real family and deserves our respect, deserves to be counted properly.
So we don't make the same mistakes again.
/end.
Please take it seriously. Remember each of those deaths was a real person with a real family and deserves our respect, deserves to be counted properly.
So we don't make the same mistakes again.
/end.
