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How death is linked to Covid-19 pandemic

ELIZABETH MERABBy ELIZABETH MERAB
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At just 33, the patient didn’t fit the description of people at high risk of complications and even death from the novel coronavirus.
It was the first death to be reported in this particular age group, challenging the dogma that young people stand a better chance of beating Covid-19.

The announcement of his death came with a new regulation that anybody admitted to hospital should be tested for Covid-19.

All the patients who have so far succumbed to the coronavirus had at least one form of an underlying health problem.

COVID DEATH

World Health Organization guidelines state in part that a Covid-19 patient who dies should be documented as a Covid death.

“A death due to Covid-19 may not be attributed to another disease and should be counted independently of pre-existing conditions that are suspected of triggering a severe course of Covid-19,” the WHO guidelines note.

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Kenya has recorded 50 deaths, with 32 occurring in Mombasa County. A death certificate can be signed by a physician who was responsible for a patient who died in hospital.

The certificate can also be signed by medical examiners or coroners, who are independent officials who work for individual counties or cities.

Although many Covid-19 death certificates are handled by physicians, pathologists are listed to determine the cause of death, said Dr Edwin Walong, a pathologist based at Kenyatta National Hospital and a lecturer at the University of Nairobi’s Department of Pathology.
Assigning the cause of death, however, is not straightforward. A patchwork of rules and regulations, coupled with the rising number of people dying at home, make getting accurate data on the exact number of Covid-19 deaths challenging.
Dr Patrick Amoth, the director-general for Health, said all patients who have succumbed to the coronavirus had an underlying health condition that might have worsened their condition.

“Most of the cases had either diabetes or hypertension. One case, the 33-year-old, had acute kidney injury,” Dr Amoth said.

In medicine, comorbidity means more than one disease or condition is present in a person at the same time.

The Health ministry had said that most patients hospitalised have some type of underlying condition.

Before Covid-19, patients with significant comorbidities were already at higher risk of other infections. These patients are considered vulnerable and are at risk of severe Covid-19 illness.

To rule out the thought that one of these comorbidities could be the cause of death and not Covid-19, Dr Amoth explained that most of the deaths documented either had multiple organ failure or were not responding to conventional treatment.

On a death certificate, Dr Walong explained, there are spaces to list an immediate cause of death, as well as the chain of events that led to that final disease or incident. There are also spaces for adding contributing factors.

“Autopsy is the gold standard for determining the cause of death. In Covid-19, the immediate cause is usually respiratory distress syndrome. Beneath this could be pneumonia often marked by inflamed lungs, which we ascertain through Xrays,” he said.

To date, Dr Walong said he has certified only one death through a minimally invasive tissue sampling. Without wide use of autopsy, he noted, cause of death can be misclassified, with different pathologists having different opinions.

TESTED POSITIVE

“We usually categorise the cause of death into two: the immediate cause and contributory cause of death. If someone who has tested positive for Covid-19 is knocked down by a vehicle, whereas I would assign that as a Covid-19 some of my colleagues will look at it as another road traffic accident,” explained Dr Walong.

The difference in opinion is largely driven by the fact that so far very little is known about the SAR-CoV-2 virus which triggers Covid-19.

“We do not know how the virus affects other parts of the body other than the lungs and the pathology of Covid-19 is still not fully understood. Therefore, it is safer to assign all Covid-19 positive cases who succumb to Covid deaths,” Opined Dr Walong, adding that this helps inform the public health response taken by the government. So far, the government has issued restrictions on movement in and out of some counties as well as other miniature regions identified to

Covid-19 is primarily a respiratory infection that attacks the lungs, making it harder for patients to breathe and get enough oxygen to the rest of the body.

In the event of death, the immediate cause of death might be listed as respiratory distress, with the second line reading “due to Covid-19.” Contributing factors such as heart disease, diabetes or high blood pressure would then be listed further down.