COVID-19: Why 3 positive cases who died from heart issues were not added to Singapore’s official death toll
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: Not adding COVID-19 patients who died of heart issues instead of the coronavirus to the official death toll is "consistent with international practice", the Ministry of Health (MOH) said.
Three confirmed cases have died of heart issues and not of COVID-19 since the start of April. Their causes of death include ischaemic heart disease and heart attack, and their deaths were not included in the official death toll of 20.
There have been medical reports linking COVID-19 with heart issues.
MOH said in response to CNA’s queries that it reports all deaths in patients infected with COVID-19.
“However, we add to the COVID-19 death count the cases where the attending doctor or pathologist attribute the primary or underlying cause of death as due to COVID-19 infection," the health ministry said.
“This has been our consistent practice, applied for both Singaporeans and foreigners in Singapore. It is consistent with international practice for classifying deaths.”
READ: COVID-19: 33 cases found to be 'false positives', including healthcare worker at Singapore Expo community care facility
MOH’s director of medical services Kenneth Mak told reporters on Friday (May 8) that the ministry’s approach is to ask if the deaths are “directly attributable to COVID-19 infection or complications related to COVID-19 infection”.
The ministry would report them as such if their deaths were related to the coronavirus, he said.
“In fact, we are quite transparent in announcing and reporting all the deaths that we have,” Assoc Prof Mak added.
“Even if they were not due to COVID-19 infection then they would be reported still, but we will not necessarily ascribe them to COVID-19 unless we have been informed by the medical authorities, whether the doctors attending to the patient or the coroner, if these were made coroners’ cases.
“If they were telling us directly that these were deaths attributable to ‘COVID-19 infection’, then we will be reporting them as such.”
MOH told CNA that 86 male foreign workers aged 25 to 59 died in 2018 in Singapore due to heart disease.
READ: Singapore reports 876 new COVID-19 cases, taking total past 23,000
THE THREE DEATHS
Three deaths among COVID-19 cases are not included in the official death toll because they died of heart issues.
A 32-year-old Indian national, case 1604, died at his place of residence on Apr 8. The long-term pass holder was tested for COVID-19 on Apr 7 and advised to stay home, pending results. His X-ray results showed he did not have pneumonia.
He was confirmed to have the disease after his demise, with MOH saying a day later that the cause of death was ischaemic heart disease and “is not due to complications from COVID-19 infection”.
A 47-year-old Bangladeshi national, Case 17410, died on May 1. He was also confirmed to have COVID-19 after his demise, MOH reported on May 2.
On May 3, the health ministry said the cause of death was ischaemic heart disease.
On May 5, a 44-year-old Bangladeshi national – Case 16370 – died of acute myocardial infarction. He was admitted to Khoo Teck Puat Hospital on Apr 29 and treated for a heart attack, MOH said.
He tested positive for the coronavirus on the same day he was admitted to hospital.
Ischaemic heart disease, also known as coronary artery disease, is when the coronary arteries are narrowed. This can cause chest discomfort, breathlessness and tiredness because of inadequate blood flow to the heart.
These narrowings happen when cholesterol and fat in layers accumulate along the lining of the coronary vessels.
When any of the three arteries gets suddenly blocked, a heart attack occurs. According to the SingHealth website, this may happen because a blood clot suddenly forms over the narrowed portion, or a fat-filled plaque bursts or ruptures.
Acute myocardial infarction is the medical term for heart attack.
CLOTTING, HEART ATTACKS LINKED TO COVID-19
Reports from doctors in China, Europe and the US have noted a dangerous complication of COVID-19 – blood clotting.
These "thrombotic events" occur for a variety of reasons among intensive care patients, but the rates among COVID-19 patients are far higher than would be otherwise expected, AFP reported.
READ: Mysterious blood clots are COVID-19's latest lethal surprise
READ: Rare syndrome tied to COVID-19 kills three children in New York, Cuomo says
A recent paper from the Netherlands in the journal Thrombosis Research found that 31 per cent of 184 patients suffered thrombotic complications, a figure that the researchers called "remarkably high" - even if extreme consequences like amputation are rare.
Another team of researchers from the New York University Grossman School of Medicine found that 18 patients with severe COVID-19 showed signs of a heart attack on their electrocardiograms, medical news outlets reported.
But more than half of these patients did not have a blockage in any major artery, the team’s studies found. These findings were published in the New England Journal of Medicine on Apr 17.
This was followed by reports on Apr 25 that the first coronavirus victim in the US, California woman Patricia Dowd, was thought to have died of a heart attack while suffering from flu-like symptoms.
Officials confirmed months after her death that she had the coronavirus, making her the US’ first COVID-19 fatality, US news reports indicate.
The Santa Clara County medical examiner wrote in the official autopsy that the Sars-CoV-2 infection, which causes COVID-19, was detected in the woman’s heart, trachea, lung and intestines, the San Francisco Chronicle reported.
READ: First US coronavirus death occurred in early February in California
She appeared to recover from her flu-like symptoms before dying of what was thought to be a heart attack, but the autopsy found she died after a valve in her heart ruptured, it was reported.
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