A Closer Look At Respiratory Death (part 5)

Lessons from an undisclosed NHS Trust

In part 3 of this series we discovered that none of the 1,574 symptomatic COVID deaths over the period Feb ’20 – Sep ’21 could be attributed to SARS-COV-2 infection alone, and we were dunked into the murky tank of multicausal death. A bar chart was produced revealing the distribution of co-morbidities along with the fact that 67.4% of symptomatic COVID deaths exhibited medical records with three or more additional diagnoses, and a staggering 91.2% of symptomatic COVID deaths exhibited patient records with two or more additional diagnoses.

I mentioned that these co-morbidities could be minor (e.g. high blood pressure) or major (e.g. stroke), the latter being a candidate for co-causal death. I have thus spent some time sifting through 2,334 diagnoses and flagging anything major yet non-traumatic that could be considered co-causal.  Examples are acute renal failure, acute hepatic failure, cerebral infarction, transplant failure, multi infarct dementia, malignant neoplasms and septic shock. At this stage I excluded all forms of traumatic injury, poisoning and wounding to get a feel for major co-causal diseases, syndromes and conditions.

In the bar chart below I have plotted out all 1,574 symptomatic COVID-19 deaths according to the number of total diagnoses made in the electronic patient record (maximum of 10 fields) and according to whether other major morbidities were also diagnosed. The chart starts off at a minimum of two diagnoses by definition (one for COVID-19 and the other for any acute respiratory condition), there being a total of 89 such cases (5.7%).  For symptomatic COVID-19 deaths with three diagnoses recorded we observe around half (51.5%) would be considered co-causal deaths, this fraction increasing with mounting case complexity. Co-causal symptomatic COVID death reaches a peak of 91.7% for records possessing a total of 9 diagnoses, there being 12 such symptomatic COVID deaths of which 11 were attributed with at least one other major morbidity.

Out of the 1,574 symptomatic COVID-19 deaths some 939 (59.6%) exhibited at least one major morbidity. Whilst we cannot attribute these deaths to stroke, heart attack, liver failure etc we cannot equally attribute them to SARS-COV-2 though, of course, this is precisely what the ONS do when they count certified deaths allegedly due to COVID. What this analysis usefully shows us is that around 60% of what the ONS claim are genuinely certified 100% COVID causal deaths should be categorised as co-causal at the very least!