The number of people who would have died from a COVID-19 infection is likely to be much higher than recorded because of death certificates don’t always list the virus as the cause of a fatality, experts say. THE CANADIAN PRESS/Nathan Denette

The number of people who would have died from a COVID-19 infection is likely to be much higher than recorded because of death certificates don’t always list the virus as the cause of a fatality, experts say. THE CANADIAN PRESS/Nathan Denette

Death certificates don’t reflect the toll of the pandemic, Canadian experts say

Deaths that have been recorded as a result of COVID-19 only reflect those who were tested for it

The number of people who would have died from a COVID-19 infection is likely to be much higher than recorded because death certificates don’t always list the virus as the cause of a fatality, experts say.

Dr. Nathan Stall, a geriatrician at Sinai Health in Toronto, said deaths that have been recorded as a result of COVID-19 only reflect those who were tested for it.

“But there are going to be people who died in excess of what we normally expected, who might have been infected and never got a test and went on to die.”

The underlying cause of death in 92 per cent of 9,500 fatalities was recorded on medical certificates as COVID-19 in a November study by Statistics Canada. In the remaining eight per cent of cases, cancer, dementia, Alzheimer’s disease or other chronic conditions were most commonly found to be the underlying cause of death.

Stall said while the 92 per cent figure is higher than what he expected it to be, he thinks the actual number is likely to be even larger.

“I think this also speaks to the confusion people have of how to actually classify a cause of death,” he said, adding those who die are rarely tested to determine if they had COVID-19.

He said the better indicator of the pandemic’s death toll will be excess mortality, when more deaths than were expected are recorded during a specific time period.

Dr. Roger Wong, a clinical professor of geriatric medicine, said the accurate recording of deaths from COVID-19 is a challenge around the globe.

The World Health Organization and medical regulatory bodies in Canada have provided guidelines on how to record COVID-19 related deaths.

Wong said an incomplete or inaccurate record of mortality data can have public health implications.

Scientists and researchers will get a better understanding of COVID-19 in people with long-standing health conditions by recording as many details as possible in death certificates, said Wong, who is also a vice-dean in the University of British Columbia’s faculty of medicine.

“It has implications, not only for COVID-19 deaths, but implications for all deaths,” Wong said.

He said the first line of a death certificate states the immediate reason a patient died, while the second and subsequent lines record health conditions leading to the cause of the fatality.

“The immediate cause of death may not capture the underlying cause of death,” he said.

In patients who die from COVID-19, they could have also suffered from acute respiratory distress syndrome and pneumonia because the virus affects the lungs, he said, giving an example.

In those cases, the first line would list respiratory syndrome as the cause of death, and the second and third lines would say what led to it, which could be pneumonia and COVID-19 respectively, Wong said. It is important to note what caused the pneumonia, he said, adding in a number of cases it could be COVID-19.

Long-standing illnesses or comorbidities, such as diabetes, heart or kidney disease, also complicate how deaths are recorded, Wong said, as those patients are at higher risk of infection.

“COVID-19 should be recorded as an underlying cause of death, not so much as a concurrent health condition that happened to be there,” Wong explained.

Stall used cardiopulmonary arrest as another example of fatalities that don’t always list COVID-19 as a factor.

“Well, everyone dies of cardiopulmonary arrest, because everyone dies when their heart stops beating and the lungs stop breathing. That’s not a cause of death. That’s the mechanism of death,” Stall said.

“The cause of death is COVID-19, and ultimately all events lead to cardiopulmonary arrest but that’s a common example that I’ll sometimes see as a cause of death when it certainly is not the cause.”

There needs to be better education and “a bit more” quality control in how deaths are recorded, he said.

“It’s not something we learn a ton about in medical school or something that’s given a lot of attention and consideration by individuals who are often in a rush to do it so the body can be released to the morgue or funeral home.”

The StatCan study said international guidelines are followed to record COVID-19 as the cause of death where the disease “caused, or is assumed to have caused, or contributed to death.”

Stall said accurately recording deaths helps stamp out misinformation about the pandemic as well as gauging how the country has been affected by it.

“We are looking at the picture and the complete scope of what COVID-19 has done to our population in our country,” Stall said.

“And in order to look after the living, you need to count the dead.”

CoronavirusDeath

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Rich Goulet receives a volunteer award from then Prime Minister Stephen Harper. (Contributed)
Petition for Rich Goulet gymnasium keeps growing

More than 4,200 seek honour for Pitt Meadows basketball coach

A drawing of the proposed Harris Road overpass in Pitt Meadows.
Pitt Meadows residents invited to road and rail project updates

Results of noise and vibration study will be made public

Amiri is currently working as a parliamentary intern. (Christian Diotte - Special to The News)
Maple Ridge woman earns scholarship to study law in Montreal

Somaya Amiri, 23, awarded McCall MacBain scholarship at McGill University

Bat Packs are the newest addition to the FVRL Playground, and have everything you need to learn more about bats, and track them in your neighbourhood. (FVRL image)
Bat Packs at Fraser Valley libraries come with echometer to track bats

Packs are the newest part of the FVRL Playground inventory

Online guide expected to make applying for building permits easier. (The News files)
City of Maple Ridge launches new building permit application tool

Users can print or save their results for easy access

Demonstrators at the legislature on April 14 called on the province to decriminalize drug possession and provide widespread access to regulated safe supply across B.C. (Jake Romphf/News Staff)
Rally calls for decriminalization, safe supply on 5th anniversary of overdose emergency declaration

From 2016 to the end of February, 7,072 British Columbians died due to overdose

Surrey RCMP are seeking the public's help to locate three puppies stolen from a South Surrey home on April 10. (Surrey RCMP photos)
UPDATE: 1 of 3 puppies stolen from South Surrey returned to owner

American Bulldog puppy recovered after being sold at Mission car show

Two women walk past ‘The Meeting’ sculptures in White Rock’s Miramar Plaza Wednesday afternoon. (Aaron Hinks photo)
New public art in White Rock faces criticism as the ‘two Michaels’ remain in China’s custody

‘I would encourage people to go out and enjoy it’ said Vancouver Biennale founder

Cannabis bought in British Columbia (Ashley Wadhwani/Black Press Media)
Is it time to start thinking about greener ways to package cannabis?

Packaging suppliers are still figuring eco-friendly and affordable packaging options that fit the mandates of Cannabis Regulations

(Government of Canada)
Liberal MP caught stark naked during House of Commons video conference

William Amos, in Quebec, appeared on the screens of his fellow members of Parliament completely naked

Provincial health officer Dr. Bonnie Henry updates B.C.’s COVID-19 situation at the B.C. legislature, Feb. 1, 2020. (B.C. government)
B.C.’s COVID-19 case count jumps to 1,168 Wednesday, nearly 400 in hospital

Now 120 coronavirus patients in intensive care, six more deaths

Moss covered branches are seen in the Avatar Old Growth Forest near Port Renfrew on Vancouver Island, B.C. Thursday, Sept. 29, 2011. THE CANADIAN PRESS/Jonathan Hayward
B.C. blockades aimed at protecting old-growth forests reveal First Nation split

Two Pacheedaht chiefs say they’re ‘concerned about the increasing polarization over forestry activities’ in the territory

Everett Cummings in a tribute video posted to dignitymemorial.com.
Mechanic’s death at Fraser Surrey Docks leads to $200K fine for company, union says

Photos of rally outside Surrey court posted on ILWU’s ‘Kill A Worker Go To Jail’ Facebook page

Most Read