By Malcolm Kendrick, doctor and author who works as a GP in the National Health Service in England. His blog can be read here and his book, 'Doctoring Data – How to Sort Out Medical Advice from Medical Nonsense,' is available here.
As an NHS doctor, I’ve seen people die and be listed as a victim of coronavirus without ever being tested for it. But unless we have accurate data, we won’t know which has killed more: the disease or the lockdown?
I suppose most people would be somewhat surprised to know that the cause of death, as written on death certificates, is often little more than an educated guess. Most people die when they are old, often over eighty. There is very rarely going to be a post-mortem carried out, which means that, as a doctor, you have a think about the patient’s symptoms in the last two weeks of life or so. You go back over the notes to look for existing medical conditions.
Previous stroke, diabetes, chronic obstructive pulmonary disease, angina, dementia and suchlike. Then you talk to the relatives and carers and try to find out what they saw. Did they struggle for breath, were they gradually going downhill, not eating or drinking?
If I saw them in the last two weeks of life, what do I think was the most likely cause of death? There are, of course, other factors. Did they fall, did they break a leg and have an operation – in which case a post-mortem would more likely be carried out to find out if the operation was a cause.
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Mostly, however, out in the community, death certification is certainly not an exact science. Never was, never will be. It’s true that things are somewhat more accurate in hospitals, where there are more tests and scans, and suchlike.
Then, along comes Covid-19, and many of the rules – such as they were – went straight out the window. At one point, it was even suggested that relatives could fill in death certificates, if no-one else was available. Though I am not sure this ever happened.
What were we now supposed to do? If an elderly person died in a care home, or at home, did they die of Covid-19? Well, frankly, who knows? Especially if they didn’t have a test for Covid-19 – which for several weeks was not even allowed. Only patients entering hospital were deemed worthy of a test. No-one else.
What advice was given? It varied throughout the country, and from coroner to coroner – and from day to day. Was every person in a care home now to be diagnosed as dying of the coronavirus ? Well, that was certainly the advice given in several parts of the UK.