The World Health Organization (WHO) set the international guidelines for coding COVID-19 related deaths.
Here are excerpts and questions relating to the document:
DEFINITION FOR DEATHS DUE TO COVID-19
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). There should be no period of complete recovery from COVID-19 between illness and death.
A death due to COVID-19 may not be attributed to another disease (e.g. cancer) and should be counted independently of pre-existing conditions that are suspected of triggering a severe course of COVID-19.
So, even if a person had a severly weak immune system and had stage 4 terminal cancer, if they contracted COVID-19 in their final days,.they are recorded as a death due to COVID-19.
RECORDING COVID-19 ON THE MEDICAL CERTIFICATE OF CAUSE OF DEATH
COVID-19 should be recorded on the medical certificate of cause of death for ALL decedents where the disease caused, or is assumed to have caused, or contributed to death.
So, if someone had influenza (similar symptoms to COVID-19), and they were not tested for influenza, but were assumed to have COVID-19, their death is coded as a COVID-19 death.
COMORBIDITIES
There is increasing evidence that people with existing chronic conditions or compromised immune systems due to disability are at higher risk of death due to COVID 19. Chronic conditions may be non-communicable diseases such as coronary artery disease, chronic obstructive pulmonary disease (COPD), and diabetes or disabilities.
If the decedent had existing chronic conditions, such as these, they should be reported in Part 2 of the medical certificate of cause of death.
A- ICD-10 Cause of Death coding of COVID-19
Certifiers use a range of terms to describe COVID-19 as a cause of death, a sample can be found in the annex of this document.
Although both categories, U07.1 (COVID-19, virus identified) and U07.2 (COVID-19, virus not identified) are suitable for cause of death coding, it is recognized that in many countries detail as to the laboratory confirmation of COVID-19 will NOT be reported on the death certificate. In the absence of this detail, it is recommended, for mortality purposes only, to code COVID-19 provisionally to U07.1 unless it is stated as “probable” or “suspected”.
Hmmm, even if not laboratory confirmed, doctors are instructed to use code U07.1 (COVID-19 Identified) on the death certificate unless it specifically states it is 'suspected' or 'probable'. But, the very next sentence says the code cannot be modified in any way. So if the COVID-19 test is negative, the initial coding cannot be removed from the death certificate.
The international rules and guideline for selecting the underlying cause of death for statistical tabulation apply when COVID-19 is reported on a death certificate but, given the intense public health requirements for data, COVID-19 is not considered as due to, or as an obvious consequence of anything else in analogy to the coding rules applied for INFLUENZA. Further to this, there is no provision in the classification to link COVID-19 to other causes or modify its coding in any way.
So, despite COVID-19 being a respiratory illness with pneumonia as a prominent disease outcome, the WHO does not want it linked in any way to any other disease or illness.
Why not? What is the issue with COVID-19 being reported the same way as Influenza, or linked to Pneumonia?
Whether a sequence is listed as accepted or rejected, may reflect interests of importance for Public Health rather than what is acceptable from a purely medical point of view. Therefore, always apply these instructions whether they can be considered medically correct or not.
Ok, this paragraph is of particular concern. This is a person's death certificate. At what point should a Doctor have to consider the interests and importance of Public Health over that of their recently deceased patient?
As Doctors, is there any other point of view they should hold other than a purely medical point of view?
How could accurately reporting the sequence of events leading to a person's death ever be against the interests of Public Health?
So basically, the WHO is requiring Doctors to follow the guidelines, even if what they end up recording on a person's death certificate is medically incorrect!
Here are some examples of how COVID-19 is to be coded on death certificates:
What does this do to the COVID-19 mortality statistics across the globe?
Australian Bureau of statistics statement regarding COVID-19 Data
Example provided by the ABS:
If a person has large b cell ymphoma (agressive cancer of the lymph nodes with a 40% fatality rate) and is on immunosuppressants and contracts COVID-19 and ends up dying, the cause of death is COVID-19 and their cancer was a condition
Shouldn't COVID-19 be a contributing factor, and the underlying cause of death was aggressive cancer?
A PUBISHED REVIEW HAS BEEN WRITTEN REGARDING THE WHO'S APPROACH TO CAUSE OF DEATH CLASSIFICATIONS WHEN RELATES TO COVID-19
Additional Sources
https://population.gov.au/data-and-forecasts/data-and-forecasts-data-release-provisional-mortality-statistics-january-december-2020.html
WHO Guidlines for recording COVID-19 as the cause of death:
Australia's guidelines align with the WHO