So the way death certificates work is that it's split into:
Part 1 - A), B) C) - A seems to be the main thing that kills someone, and then B) and C) are the medical issues that likely lead to 1A.
Part 2 - Other co-morbidities that the patient had but may not have directly contributed to that person's death.
Now when it comes to this topic, the thing I read the most is that "the government" or "the NHS" just puts Cornavirus-19 down on the death certificate even if they never died from it.
I think a good example is today where, once again, I had another woman pass away today. She became COVID positive on the very start of the month, and unfortunately picked up a bacterial pneumonia on top - given her weakened immune system. After 4 days, she passed away today. When it'll come to me doing her death certificate tomorrow, there's scope to say that 1A would be the Hospital-Acquired Pneumonia, and then 1B would be Coronavirus-19. I could quite easily put Coronavirus-19 down as Part A because quite frankly, she was doing so poorly with it in the first place that it's likely she was going to pass away from it sadly. The bacterial infection just seemed to catalyse everything.
Whether I put it as 1A or 1B is actually moot - at the end of the day, from what I see clinically, COVID-19 has killed this lady unfortunately.
Whether I put it as 1A or 1B, I don't think it should raise any controversy whether the government uses it as a figure towards the number of deaths - because it 100% played the major part in the death of this lady.
Now I keep hearing that people put COVID-19 down even if they were asymptomatic with it, or that they had it and had mild symptoms but was hit by a falling seagull from the air so "we have to put COVID down on the death certificate".
Of course the example I've used is preposterous but my point stands.
I've had patients that are asymptomatic from COVID, but have died from a brain bleed - but I have not put down COVID at all down on the death certificate because they aren't linked at all.
I have also never put COVID down on a death certificate "because they've had it at some stage in the last 28 days" and died. I've had a couple of patients die of a bog-standard bacterial pneumonia but had COVID (asymptomatic) almost a month prior - but I have not put COVID down on the death certificate because all the other tests pointed at it being a bacterial cause or an aspiration cause rather than viral COVID pneumonitis.
Long, lengthy post so I do apologise but I just thought I'd share what they bang on about when it comes to death certificates. I didn't want to bring more common presentations because naturally some have lost members of family through non-COVID conditions during the last few months and I think people do forget that. Medicine has continued despite COVID and we still deaths that are fully unrelated to COVID.
Fine, I can't speak for all doctors/hospitals. That is 100% true and maybe I shouldn't put a blanket statement like I said. But I've worked in two hospitals during the COVID pandemic, and from my experience in both, COVID has only ever been put on the death certificate only if it's played a massive contribution towards the death - and the vast, vast, vast majority - COVID is 1A. I am working on the Respiratory COVID ward, so granted we get the sickest COVIDs in the hospital before they are deemed to require intubation in ITU - so naturally I am going to see more deaths that are full barn-door COVID. But I also help the more junior members of the team on the non-COVID Respiratory ward - and work on calls where I see a whole concoction of presentations who may die on admission. In my current hospital, there's guidance for us to say to only put down COVID if its played a role in their deaths. I can safely say that I'm part of the cohort in my hospital who have seen more COVID in the last few months than anyone else in the hospital - which unfortunately means I've done a fair few death certificates so I feel I can hold a fairly valid opinion on this whole death certificates debacle.
