A Closer Look At Respiratory Death (part 3)

Lessons from an undisclosed NHS Trust

In the first part of this mini-series I mentioned the rather awkward fact that an adult in-hospital death whose diagnostic record included both an acute respiratory diagnosis and a positive COVID-19 test result may not necessarily have died directly from respiratory failure attributed to SARS-COV-2. There’s sepsis to consider, plus organ failure and cardiac troubles as well as neurological issues including stroke, not to mention iatrogenic causes. Whilst COVID-19 may well contribute to some or all of these - especially through induction of a cytokine storm - or even be the genuine underlying cause of death I am hoping members are appreciating just how muddy the water is when it comes to assigning death to a single underlying cause.

A clue to the difficulty is given in the acronym MUSE (multicausal and unicausal selection engine), this being the software that ONS use to automatically process the thousands of death certificates registered each week. Only in the case of inquests and post-…