The Reporting Of Deaths

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From top: Latest update on the Department of Health’s Covid-19 dashboard; Dublin Coroner Dr Myra Cullinane

This morning.

The latest Department of Health figures show that, as of April 15, there were 444 Covid-19 deaths in Ireland, 290 associated with residential settings, including 245 in nursing homes.

Last week, the department confirmed that when calculating its death toll, the department counts “any death that involves a positive Covid-19 test” and any person whose remains test positive for Covid-19 during a post-mortem.

This would appear to suggest that any person who has tested positive for Covid-19 will be listed as having died from Covid-19 regardless of the actual cause of death

Further to this…

This morning Paul Cullen reports in The Irish Times that the Dublin Coroner Dr Myra Cullinane has warned that “not all Covid-19 deaths are being reported as required by law“.

Mr Cullen reports:

…Dr Myra Cullinane has written to medical staff in hospitals and other locations who are responsible for completing death certificates saying they must comply with the requirement to report “any death in the context of proven or suspected” Covid-19 to her office.

Her warning comes amid concern over possible under-reporting of deaths from the virus, particularly outside hospitals. Analyses of online death notices in recent weeks have suggested a level of excess mortality not captured in official figures.

…In her letter, Dr Cullinane reminds medical staff of the requirement under the Coroners Acts to report virus deaths. She adds: “It has been drawn to my attention that such reporting is not taking place in all cases.”

Meanwhile, earlier on RTÉ’s Morning Ireland

Broadcaster Dr Gavin Jennings asked Dr Siobhán Ní Bhriain, National Lead for Integrated Care with the HSE, if she’s “sure that all deaths for Covid-19 or suspected in care centres and in nursing homes are being reported as Covid-19 deaths“.

Ms Ní Bhriain replied:

I couldn’t say with absolute certainty, Gavin, that they are being reported as such. I do, we do wonder, if at the early stages of the disease, when we didn’t suspect it was Covid, there may have been a couple of deaths that occurred early that would not have been typically Covid in terms of symptoms.

“But we have a review system in place to look back over all those deaths reporting, that were reported. And we will be reviewing that.”

Listen back to the interview in full here

Some Covid-19 deaths are not being reported, coroner warns (Paul Cullen, The Irish Times)

Related: 881 patients in acute hospitals with Covid-19, 448 suspected cases (RTÉ)

Previously: Counting ‘Every Death’ That ‘Involves A Positive COVID-19 Test’

Meanwhile.

More than nine in 10 people [in the UK] dying with coronavirus have an underlying health condition, figures from the Office for National Statistics show.

The ONS looked at nearly 4,000 deaths during March in England and Wales where coronavirus was mentioned on the death certificate.

In 91% of cases the individuals had other health problems.

The most common was heart disease, followed by dementia and respiratory illness.

On average, people dying also had roughly three other health conditions.

Coronavirus: Nine in 10 dying have existing illness (BBC)

52 thoughts on “The Reporting Of Deaths

  1. Brother Barnabas

    even if just “suspected” to be covid19-related ?

    every year there are between 3,000-4,000 deaths with “Diseases of the Respiratory system” noted as the cause of the death

    are these to be all classified as covid19?

      1. NewName

        What methodology do you think they should be using?

        Do you think the level of deaths has been significantly understated?

    1. ReproBertie

      “are these to be all classified as covid19?”
      Pretty clearly states that a positive Covid-19 test result is required first.

      “The Coroners Service has advised that deceased patients with respiratory failure and suspected Covid-19 be swab tested so that positive cases can be reported.” according to the Irish Times article linked above.

        1. ReproBertie

          Does seem a bit odd but then I’m not a medical professional and have no idea what other factors are taken into account when counting the Covid-19 deaths. A family member working in a respiratory ward in one of the Dublin hospitals told me that they only pass on the numbers when Covid-19 leads to the death of one of their patients. Does that mean they died from Covid-19 or that Covid-19 was a contributing factor? I don’t know but I presume that’s why having an underlying condition is such a concern.

          1. Bodger

            ReproBertie, you could have the virus and not even know it, die from another illness, but your death is then recorded as Covid-19.

          2. Brother Barnabas

            yes but it does seem the presence of underlying condition is being ignored when it comes to recording to the death

            generally agreed that it someone is otherwise healthy, contracting coronavirus wont be a major issue. but if you have, for example, chronic heart disease, it definitely will be an issue. it’s the main factor in determining whether you die or not, so surely that should he the main cause of death. if anything, covid19 was the catalyst.

          3. ReproBertie

            Perhaps Bodger but we don’t have all the details and without the details it’s just speculation. I’m not saying you’re wrong. I’m saying we don’t know.

            Brother, if Covid-19 was the catalyst that resulted in someone with an underlying heart condition dying then should that not be recorded as a death caused by the pandemic?

          4. Brother Barnabas

            maybe, maybe not

            lets say 100 people contract covid19 – 99 have no underlying conditions and breeze through it but 1 has chronic heart disease and dies. what did the 1 die of?

            certainly, the virus was a factor, but, imo, it cant be deemed to be the principle cause of death

          5. Donnchadh

            It might help to distinguish some of the different claims being made here.

            The presence of underlying conditions is being ignored in patients reported to have died from C19 – is this happening in any significant numbers? For instance, I thought that the daily updates were including figures on deaths where the patient had underlying conditions?

            Anyone who tests positive for C19 and then dies is assumed to have died from C19 – as I’ve said before, this seems like a reasonable assumption in the present circumstances (excepting cases where the virus clearly had nothing to do with the patient’s death). Saying that a patient died of C19 is compatible with saying that they also died of other causes. No doubt there will be cases where C19 was present and played no causal role, but afaik it is very difficult to establish this, and until there is a robust method to do so I would be inclined to assume that C19 played some role where it was present.

            All suspected cases have to be reported – I’m happy with this as well. They shouldn’t be included in the death count without a post-mortem, but is this happening at present?

          6. Some old queen

            @ Donnchadh

            Why is it reasonable to assume that when a patient with comorbidities dies, that CoVid-19 which has a death rate of (roughly for the sake of argument) 1% is the cause?

          7. Donnchadh

            SOQ,

            Thanks for the question. First, I don’t suggest that we should assume it’s ‘the’ cause, rather that it is ‘a’ cause, i.e., one among others (including the co-morbidities).

            To the best of my knowledge – and I am certainly open to correction on this – it is often very difficult to establish, if a patient has a number of conditions each of which significantly increases the chances of them dying, whether one, some or all of these conditions contributed to their demise. Obviously depending on the exact proximal cause of death, some of these conditions will seem less relevant, but that will still leave a fair degree of uncertainty. There is also the fact that different conditions contribute in different ways to someone’s dying. For instance, afaik many patients who are recorded as dying from AIDS are not killed by this syndrome – rather, it wekaens their immune system and increases the chances of their expiring from other causes. Nevertheless, I think it is reasonable to say that AIDS contributed to their deaths.

            Why assume that C19 is relevant? Because where it has spread rapidly there has been a huge upsurge in deaths, and even where many of the people recorded as dying from C19 had comorbidities, my understanding is that it is extremely unlikely that their deaths would all have occurred together in this way. So it is reasonable imo to assume that C19 is playing a role in bringing these deaths about, until we have good reason to think otherwise.

          8. some old queen

            I agree which is why all comorbidities should be on the death cert.

            We have seasonal flu which takes quite a few as well of course but I don’t think it is usually entered as cause of death.

            There is obviously an urgency to record the numbers of this virus but just totalling those who had CoVid-19 on it’s own may give quite a skewed picture.

            One thing that puzzles me is how it found its way into nursing homes so quickly- it would suggest a very high number of asymptomatic carriers.

          9. Donnchadh

            Are co-morbidities not being mentioned on the death certificates? That would strike me as very odd (that said, I don’t know what the usual practice is in such cases).

            As regards nursing homes, while there are a very high number of deaths originating in nursing homes, what’s not clear is whether there is an unusally high number of cases there. But since it has been clear for some time that the elderly are in general more vulnerable, one might wonder whether enough was done to prevent the spread of the virus in nursing homes.

      1. Brother Barnabas

        “…Dr Myra Cullinane has written to medical staff in hospitals and other locations who are responsible for completing death certificates saying they must comply with the requirement to report “any death in the context of proven or suspected” Covid-19 to her office.”

        pretty clearly states “proven or suspected”

    2. alickdouglas

      There is not nearly enough caution being exercised with interpretation of raw data. What we are seeing here is day by day reporting ‘raw data’. Mortality (or indeed other health data) isn’t usually subjected to instant reporting and interpretation because biases need to be investigated, spurious data removed or corrected and analysis done. Usually we allow teams of people with an actual epidemiology qualification (Masters or PhD) to do that. When done right the treatment of bias is usually treated using well tested tools and explained thoroughly (for example, but not exclusively in reviews in peer-reviewed literature). So no, it’s not bizarre, it’s raw data.

  2. GiggidyGoo

    “444 Covid-19 deaths in Ireland, 290 associated with residential settings, including 245 in nursing homes”

    55% of the deaths are in Nursing Homes themselves. But – THE HSE advised staff in nursing homes they did not need to wear vital PPE equipment when dealing with residents who may have Covid-19.

  3. Andrew

    What’s this? Someone stepping out of line? Could we be possibly under-reporting deaths form this virus? Surely not? Surely our journalists and commentators insatiable appetite for the truth would have uncovered this already?
    They would have questioned if decisions were being made in nursing homes NOT to send residents to hospital and questioned who was making these decisions? They would have questioned the HSE advice to nursing homes regarding PPE? Of course they would have.Wouldn’t they?
    Someone send this woman a memo and a green jersey quick!
    Now as you were, get back to Trump and Boris bashing and patting ourselves on the back!

    1. ReproBertie

      “They would have questioned if decisions were being made in nursing homes NOT to send residents to hospital and questioned who was making these decisions?”

      Have you questioned why some residents are being treated in the nursing homes rather than being sent to hospital?

      1. Andrew

        Is that up to me? I’m not a journalist but I’d hazard a guess Bertie, that some residents are too frail. That’s not the point though is it? If we are having a conversation about euthanasia the let’s have it. Let’s not pretend it isn’t happening. But if it is happening, people have a right to know .There has to be checks.Surely it is worthy of a discussion at least?

        1. ReproBertie

          But we’re not having a conversation about euthanasia. The figures show that people are being moved from nursing homes to hospitals. 54% of deaths were people who had been in nursing homes but only 42% of deaths were in nursing homes. That’s 12% of the overall deaths being people who were moved from nursing homes to hospitals where they later died. We do not yet have figures for those who were moved and recovered.

      2. GiggidyGoo

        I wonder what treatment is available to people in nursing homes for Covid-19, given the age of the residents. Are there respirators available for instance?. There haven’t been enough nurses available so far, and the HSE is asking nurses to ‘volunteer’.
        I doubt if there is any real treatment available in nursing homes. It’s into ‘Three Wise Men’ territory as far as I can see.

          1. GiggidyGoo

            I’ve looked as far as yourself then.
            The absence of enough nurses gives a clear indicator of the potential situation. But sure, go ahead with attacking me, rather than giving your pennyworth on what is or isn’t happening in the nursing homes.

          2. ReproBertie

            I don’t know what’s happening in nursing homes. Nor do you. I don’t use that lack of knowledge to post comments like “I doubt if there is any real treatment available in nursing homes”. That’s the fundamental difference between you and me.

          3. GiggidyGoo

            Well, I’ve checked. Local nursing home. No respirators. No PPE. One part-time nurse. And the treatment? – ‘make the person comfortable’
            So, I don’t need to use ‘I wonder’ or ‘I doubt’ then.
            There you go. That’s the difference between you and I – I tend to find out
            So now that you’ve been informed, where do you go from here – find out for yourself perhaps?

          4. ReproBertie

            Thank you for checking. When they said “make the person comfortable” did they happen to mention if that was in all cases or in cases with mild symptoms? Of course one nursing home is insufficient evidence to claim that there is no real treatment in nursing homes.

            I’m not saying there is by the way. In fact, since we know nursing homes are sending patients to hospitals it’s quite possible that the available treatment is quite minimal but then we don’t expect nursing homes to be equipped with ICU beds.

          5. GiggidyGoo

            I’m sure you could find out Repro. If you wanted to, that is instead of nit-picking. Why don’t you do yourself a favour and do so, so that you can write with a bit of knowledge?

          6. ReproBertie

            There’d be no need to nit pick if people refrained from posting fearmongering speculation.

          7. GiggidyGoo

            Hi SOQ. I don’t mind discussing things, like you yourself do, but there’s a tendency by some posters (many of their names beginning with the letter ‘R’) to attack the poster rather than the subject.

          8. ReproBertie

            Dr. Jack Lambert, a specialist in infectious diseases in the Mater, has said that what is happening in our nursing homes amounts to a national emergency and has called for the redeployment of healthcare staff to nursing homes.

            From that I’m taking it that you were pretty close to the mark with your estimation of what is happening in nursing homes.

            I remember when word broke about abandoned people dying in a nursing home in Spain we were told that we would not see anything like that happening here. Hopefully there will be a reaction to this call from Dr. Lambert and that statement won’t be just another lie.

        1. SB

          Don’t you need 6 highly-trained ICU nurses to be able to operate every one respirator? Not much point giving a nursing home a respirator if they don’t know how to use it.

        2. Cian

          @GiggidyGoo
          Can you explain how a “respirator” is used to “treat” COVID-19? because I think you may be mixing up terms.

      1. Nigel

        Because claiming the Irish government is getting an easy time from the BS commentariat is too much gaslighting for even Charger to do under his usual name

        1. Hansel

          It seems to just be neverending, over the last few weeks.

          If someone managed to find a cure for cancer but happened at one point to know someone who worked in a government agency, there’d be something on here about how they aren’t trusted because they’re in league with the lizard people.

  4. Joe Small

    Not sure if this has been referenced already but Seamus Coffey on twitter has done some useful work, using RIP.ie to track the increase in deaths in recent months compared to other years. He updates his figures frequently.

    https://twitter.com/seamuscoffey

    Undertakers tend to publish notices shortly after death while the current law allows up to three months to register a death. Its imperfect but he’s making innovative use of available data.

  5. Matt Pilates

    Why is the death\positive cases rates announced in the evening (sometimes as late as 9 PM)? Do they spend all day figuring out a way to spin their “numbers”? Surely announcing the latest figures at 9 AM would be a better reminder for the day…

    1. Hansel

      Their numbers are from 1PM AFAIK.

      Your argument can be used for any time of day: if they announced them at midnight, they’ve spend all day at it. If they announced them at midday they spent all morning at it. If they announced them to the second, their data is incomplete and they’re insensitive. So there’s no perfect or imperfect time to report.

      They picked 1PM as their “time of day” and their conferences follow at all sorts of times, invariably the evening. I presume where they spend the day and what they spent the time working on dictates the conference time.

    1. mexican

      Incorrect, direct from the ONS website: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/weeklyprovisionalfiguresondeathsregisteredinenglandandwales

      There’s a weekly breakdown of deaths so far this year, March is more or less on line up to the last week. From March 27th to 3rd April, there were 16,387 deaths. The 5 year average for that same week is 10,305. That is a huge skew compared to the variances on other weeks for 2020.

      1. some old queen

        Yes that is one week rather than the month?

        I would have assumed it would have impacted overall deaths earlier than that.

        1. mexican

          Yes, it’s for one week but a significant week when you look at the data from https://www.worldometers.info/coronavirus/country/uk/ their rate of reported deaths from Covid was pretty low until around 26th March and started climbing from then. That week has approx 55-58% higher rate than the 5 year average which is eye opening to say the least and you could make an assumption that is all reported and unreported Covid deaths.

          The following week 3rd-10th April will be published in a couple of days and potentially could have the same if not more of a deviation to the 5 year average.

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