Reporting of COVID-19 deaths not 'clear-cut', official numbers may not reflect true toll: Expert

Reporting of COVID-19 deaths not 'clear-cut', official numbers may not reflect true toll: Expert

SARS-CoV-2 COVID-19
Image from the National Institute of Allergy and Infectious Diseases (NIAID) shows a colorised scanning electron micrograph of an apoptotic cell in red heavily infected with SARS-CoV-2 virus in yellow. The SARS-CoV-2 virus causes COVID-19. (Handout: NIAID via AFP)

SINGAPORE: Reporting the number of deaths from COVID-19 is not as straightforward as it may seem due to several reasons, said infectious diseases expert Professor Dale Fisher on Thursday evening (Jul 23) in a webinar.

The chair of Infection Prevention and Control at the National University Health System (NUHS) highlighted this in an online talk which also featured the editor-in-chief of British medical journal the Lancet, Richard Horton.

Giving an example of a person who was in a traffic accident, Professor Fisher said that in such a case, it was clear that just because the victim had COVID-19 did not mean that the cause of death was the disease. 

"Having COVID-19 and dying does not mean you died from COVID-19. In short, it has to be resulting from a clinically compatible illness in a probable case," he said in a virtual lecture that is the latest in a series of COVID-19 updates organised by the National University of Singapore's Yong Loo Lin School of Medicine and NUHS.

READ: 354 new COVID-19 cases in Singapore, including 8 community infections

However, there have been cases of heart failure in COVID-19 patients which may not be as clear-cut. Prof Fisher pointed out that COVID-19 is associated with "thromboembolic phenomenon" and "vasculitic phenomenon", or blood clots and inflammation of the blood vessels. 

According to World Health Organization (WHO) guidelines, heart failure due to myocardial infarction with COVID-19 is not classified as a COVID death. He said: "We are actually following this, but it's already showing some of the complexities."

In Singapore, there have been a number of deaths related to heart or blood issues which were not added to the official COVID-19 death toll of 27. 

Doctors here were in June advised to be “watchful” for cardiovascular symptoms in COVID-19 patients, with “emerging data” globally about the increased risks of blood clots and heart disease in such patients. 

READ: Man who died from heart disease later found to have COVID-19

Professor Fisher also said that the official reports from various countries may not reflect the true death toll of the disease. More than 620,000 deaths from the coronavirus have been reported globally. 

Comparing deaths from all causes from June this year and in previous years, he pointed out that the increase in deaths in some countries compared to the average in previous years has exceeded the number of reported COVID deaths. 

In the US, the difference between the "excess deaths" and the reported COVID-19 deaths amounted to about 30,000, he estimated.

"So pretty much in most of these countries - not all of them - we find the excess deaths are more than the baseline plus COVID - so this brings you to wonder why," he said.

This could be due to undiagnosed or unreported COVID-19 cases, due to some cases that do not meet WHO definitions, or there could more deaths from non-COVID diseases, he said.

"So the moral of the story is that we really should be looking at all-cause mortality, rather than bringing in the subjectivity of saying 'was it caused by COVID?'" he said.

READ: Don't expect first COVID-19 vaccinations until early 2021: WHO expert

PROXIMITY BETWEEN SCIENTIFIC AND MEDICAL COMMUNITIES AND POLITICAL CLASS KEY IN BATTLING COVID-19: EDITOR-IN-CHIEF OF THE LANCET 

Professor Fisher was speaking after editor-in-chief of the Lancet, Professor Horton, answered questions from the viewers on "Learning from COVID-19 to build a resilient future".

The professor is known for his scathing criticism of the UK and US governments' pandemic response, but he said that Singapore, like a number of other small states, have handled the outbreak well.

Responding to a question on Singapore's management of COVID-19 so far, Prof Horton said: "I think Singapore's been an exemplar ... There is an ability to have a proximity between the scientific and medical communities and the political class. 

"When I look at New Zealand, for example, (Prime Minister) Jacinda Ardern has just been incredible because she got good science policy advice and she's close to the science policy and medical community, and it's the same with (Singapore) ... So I think small can be good."

He said that countries who had leaders that are trained in the sciences appeared to have done better, for example Germany's Angela Merkel.

"Certainly in my country, science is not a background for many political leaders and civil servants ... you need to have a mix in government, you need to have people who do have literacy in science," the Briton said.

Prof Horton also defended a Lancet editorial which said that US needs a president in the White House who will not let public health be guided by partisan politics in response to another participant's question.

"The great leaps in health that have taken place over recent centuries haven't just come because of some great randomised trial published in a journal, the great leaps in health have come through political struggle," he said.

"Are we going to stand on the sidelines and say that's not a struggle for us? I mean that's completely ridiculous. We should be absolutely on the front line of that political struggle."

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Source: CNA/hm(rw)

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