I got a question yesterday I've been asked before, so I thought it would make a good FAQ Friday. It had to do with rumors that a federal or state agency has 'pressured' or encouraged coroners, medical examiners, etc., to state COVID-19 as a cause of death even in lieu of other causes. Usually the supposed reasoning has to do with funding incentives.
First, let me state that absolutely NOBODY tells me what to put on a death certificate. Ever.
When I sign the certificate, what I have stated as the Cause of Death, Manner of Death, and Contributing Conditions is the result of my work. Whatever I felt compelled to examine, investigate, and research in regards to each deceased person. Almost 100% of the time, I request medical records FAR in excess of recent history.
This gives me a 'baseline' picture of the decedent's health even if not directly related to whatever caused their death. Then there are physical exams, toxicology, blood chemistry, and autopsies if needed; I can interview physicians, caregivers, and family members familiar with the person's condition, illness, and death if I think it's necessary.
So when I sign that certificate, I place my name stating that to the very best of my knowledge, the cause of death is correct. And can be well substantiated by the work I mentioned.
So, when WOULD I list COVID-19? Good question. Let's use a made-up case.
Let's say a 75 year-old male has COPD (Chronic Obstructive Pulmonary Disease) and has been treated for this condition for 10 years. He visits his doctor regularly, receives medication, takes it, and does well long-term. But let's say he contracts COVID-19, develops respiratory complications, and passes away. What is the cause of death in this case?
The correct answer is COPD. . . with a contributing factor of COVID-19. Why? Because COVID is well shown to exacerbate existing medical conditions. This isn't to say a person can't die from COVID by itself, unfortunately of course they can. But it is far more likely (and so far, documented) that COVID makes symptoms of pre-existing conditions worse.
Another way to think about it is to use the phrase "but for." As in... "but for" _____________, would this person have died? The person in my example had COPD, but was treated and surviving with the condition. It was therefore less likely for him to die solely from COPD. Had he not contracted COVID, he would likely not have died in this way; in other words, "but for Covid."
That is the most likely scenario for listing COVID-19 on a death certificate, as far as I'm concerned. Exacerbation of a pre-existing condition where I'm convinced COVID hastened the person's demise.
Otherwise, if it's not involved, it's just not involved. And would never be listed by me. Period, amen, ever.
Have a great weekend, everyone!
Greg Mullinax
Bates County Coroner
