Yesterday the Cabinet decided to set up a “fact-finding committee” presided by a former judge to look into the “recent death of renal dialysis patients”. When Covid spread into the Souillac dialysis centre, 11 patients died – some of Covid, some of existing conditions, others not Covid positive. The Cabinet action was a response to massive political pressure from the Opposition that put the deaths at the centre its political campaign to shake the Jugnauth Government.
Let us look at one aspect of this “political battle”: How do you decide on “cause of death” on death certificates?
Yesterday, the Government site “besafemoris.mu” at 11:30 am put total deaths from the whole Covid-19 epidemic over both waves as sixteen (16). On the same day, 23 April, Le Mauricien put the figure at twenty-four (24) *. (Le Mauricien did, however, specify that it meant “de patients Covid positifs”. This means not necessarily due to Covid-19.)
I do not know if Le Mauricien is questioning the Government statistics. Anyway, it is the doctor treating the patient that fills in the form. Government collects the forms and adds up. We also all know there is a standard form for death certificates. I happen to know that there is a delicate, thoughtful procedure demanded of doctors. Over the years, when I would accompany Ram after deaths at a patient’s home, I would see Ram, after detailed examination, study his patient’s treatment card, mull over years, then months, then weeks of illness, in order to make a precise entry. I must report, also, that Ram has often found fault with the filling out by some doctors of death certificates as seen in press reports or presented as evidence in court cases of police violence that LALIT monitors. Ram summarizes a common fault as being the doctor writing the equivalent of no more than, “Someone died because his heart stopped beating”, which is a tautology – if you do not at once begin resuscitation – and not a proper cause of death.
Anyway, 16 deaths or 24 deaths – Le Mauricien’s figure 150% higher than Government’s – is an alarming discrepancy. If we take only the 2nd Covid wave, it is even worse: 6 deaths or 14 – one over twice the other. Thus the importance of looking into this today, and not just waiting for a Committee presided by a former Judge to do so. Knowing four things, we can at once see the problem for treating doctors: Covid-19 is often asymptomatic; people with pre-existing conditions get severe cases of Covid; Covid has varying symptoms; Covid in a dialysis centre (or radiotherapy ward) infects some very fragile patients.
So, I Googled the W.H.O. site for its guidelines. Read carefully an example of one clear case of a death caused by Covid and one clear case of a death NOT caused by Covid. Then judge for yourself:
“International Guidelines for certification and classification (Coding) of Covid-19 as cause of death”. In the introduction I see that the words “due to” in the phrase “cause of death due to Covid-19” are underlined. I take note.
One Example of a Covid-caused Death Certificate filled in by a doctor:
“1. Report the disease or condition directly leading to death on line a: ..... Acute respiratory distress syndrome [2 days]
“Report chain of events in due to [sic] order (if applicable) . .... Pneumonia [10 days]
“State the underlying cause on the lowest used line. ..... Suspected Covid-19 [12 days].
“2. Other significant conditions contributing to death (time intervals can be included in brackets after the conditions).
...... Coronary artery disease [5 years], Type 2 Diabetes [14 years], chronic obstructive pulmonary disease [8 years].”
This, the WHO page says, IS a death due to Covid, for the purposes of the record. You don’t even need a positive test.
There are two examples of death NOT due to Covid filled in on the same “form” – one is easy because someone who tests positive has a motor vehicle accident, dies of injuries. Covid, in this case, is not involved at all.
The other is worth reproducing below for you to study:
“1. Report the disease or condition directly leading to death on line a: .... Heart failure [1 day]
“Report chain of events in due to [sic] order (if applicable) ...... Myocardial infarction [5 days]
“2. Other significant conditions contributing to death (time intervals can be included in brackets after the conditions). ...... Covid-19.”
This is NOT, according to the WHO site, a death due to Covid, for the purposes of standardized records. So, Le Mauricienmight have difficulty in maintaining its figure against those filled in by the treating doctors. I see no reason, incidentally, why doctors would intentionally falsify the reports to deny Covid as a cause. On the contrary, it is to their credit that they did not just put the cause on to Covid-19 – which is elsewhere the main criticism of official statistics.
What we need now is the compassion and calm to help dialysis and cancer patients, Covid positive or in quarantine, and their families to keep the kind of serenity that will be beneficial to their health. We appeal to Opposition leaders to put the “care” of patients first during a health emergency. And meanwhile also, each and every one of us, need to counter anti-vaccine lies, and use our voices to encourage dialysis and RT patients and health staff to take up the vaccine.
* lexpress.mu put the figure at 16 like the official figures. But, underneath is: “+6 nouveaux”, which I assume means not “PLUS” but perhaps maybe “2ème vague 6”?