“No more than speculation”

I signed death certificates during the COVID-19 epidemic, and that’s why mortality statistics should not be trusted

I’m a physician in the British National Health System and I see dead people being recorded as coronavirus victims without even having to be tested. But without accurate data, we (never. - RT ) will not know why more people died - because of the virus or because of isolation.

I think most readers will be somewhat surprised to learn that the cause of death often indicated in official certificates is no more than an assumption. People die mostly in old age, often when they are over eighty. In such cases, an autopsy is performed extremely rarely, which means that you, as a doctor, have to analyze the patient’s symptoms for about the last two weeks of life and check the medical records for any diseases.

Has a person had a stroke before, did he suffer from diabetes, chronic obstructive pulmonary disease, angina pectoris, dementia and the like? Then you talk with relatives and caregivers to find out what picture they were seeing. Did the patient have breathing problems? Or maybe he slowly faded away, refusing to drink and food?

If I observed a patient in the last two weeks of his life, what, in my opinion, was the most likely cause of death? Of course, other factors are not excluded, for example, a fall, a fracture, an operation. In this case, in order to find out what exactly was the cause of death, an autopsy will most likely be performed.

If a person has died outside the hospital walls, the data in the death certificate is in most cases far from accurate. They never were and never will be. But in medical institutions, where they often resort to analyzes, tests and various kinds of examinations, the accuracy of indicating the causes of death is really a little higher.

However, with the advent of the coronavirus, even many of these meager rules were no longer followed.

Moreover, at a certain point, a proposal was made to allow relatives to independently fill out death certificates if it was impossible to contact a specialist. However, I’m not sure what came to this.

And what was the doctors to do? If an elderly person died in a nursing home or at home, was the cause of death of COVID-19? In truth, who knows, especially if a person hasn’t been tested for coronavirus (for several weeks this was not allowed at all). Testing was intended only for those who were in the hospital, and no one else.

What were the recommendations? They varied throughout the country, from coroner to coroner, and new ones arrived every day. Is it necessary to consider that anyone who died in a nursing home died from a coronavirus? Well, in some parts of the UK it was recommended that this be the case.

The place where I work has remained more open in this regard. I discussed the state of affairs with my colleagues, but we did not succeed in reaching a common opinion. In some death certificates, I indicated the cause of coronavirus, in some not. It all depended on how, in my opinion, a person died.

I know that since the beginning of March, some doctors have indicated COVID-19 as the cause of death for all who died. Me not. What conclusions can be drawn from statistics compiled on the basis of such data? And is it important?

It is very important, and for two reasons. First, by overestimating the number of deaths from coronavirus, we will downplay the harm from isolation. This topic has recently been raised in an article in the British medical journal The BMJ. The article said: “Only a third of the excess deaths in England and Wales can be attributed to the coronavirus.

... David Spiegelhalter, head of the Winton Center for Information Exchange and Risk Research at the University of Cambridge, says that COVID-19 does not explain such a high mortality rate. "

“During a briefing held on May 12 by the Scientific Press Center, he explained that in the past five weeks, nursing homes and other social institutions have“ an incredible burden ”because the number of deaths exceeded the expected figure by 30 thousand due to the fact that patients were discharged from hospitals in anticipation of a large demand for beds.

Only 10 thousand of these 30 thousand people indicated COVID-19 in the death certificate. Although Spiegelhalter admits that some of these “excess deaths” can be attributed to incomplete coverage of the diagnosis, “the number of unexplained and excess deaths in ordinary homes and nursing homes is simply going through the roof. When we analyze what has happened ... such an increase in non-coronavirus-related deaths outside hospitals, I hope will attract close attention. " He added that many of the deceased “could have lived longer if they had managed to get help in the hospital.”

That is, Spiegelhalter says that coronavirus may not be the main, but rather a secondary cause of death of people, that is, they can die due to quarantine, because they are not placed in a hospital to treat symptoms that are not related to COVID-19. It is known that since the beginning of isolation, the number of calls to emergency medical departments has decreased by more than half. The same goes for chest pain treatment. Did all these people just die at home?

In my experience, getting an elderly person hospitalized has really become incredibly difficult. Recently, I succeeded with one old man who began sepsis, not associated with coronavirus. And if he had died in a nursing home, then COVID-19 would almost certainly have been indicated as the cause of death.

All this to the fact that if we do not correctly diagnose death, we will never know how many people died from the coronavirus or "due to" quarantine. Those who advocate isolation and make recommendations to the authorities can refer to the lethality of COVID-19 and say that we have chosen the right path. However, in reality, quarantine itself could have caused no less deaths, because all medicine was thrown into the fight against a single disease, and therefore patients, people at risk, could not get to hospitals.

Another reason accurate statistics is so important is planning for the future.

We need to know exactly what happened this time in order to be able to prepare for the next pandemic, which, in view of the growing population of the earth, seems almost inevitable. What are the advantages of quarantine and its disadvantages? What to do the next time we encounter a deadly virus?

If COVID-19 caused the death of 30 thousand people, but exactly the same number of people died due to quarantine, does this isolation regime make a completely waste of time and a mistake that cannot be repeated anymore? The worst thing is that the state may not be happy with this promise - and the authorities will do everything possible to ignore it.

It will be stated that all above-average death rates this year were associated with coronavirus. And this is the easiest way to retreat if no one has the slightest idea who really died from COVID-19 and who doesn't. So coronavirus mortality statistics really matter.

The author’s point of view may not coincide with the position of the publisher.