Coronavirus being left off english death certificates

[Javert]

To me, a non-medic, the document appears clear and unequivocal:



How to complete the cause of death section

• COVID-19 is an acceptable direct or underlying cause of death for the purposes of completing the Medical Certificate of Cause of Death

• COVID-19 is not a reason on its own to refer a death to a coroner under the Coroners and Justice Act 2009.

• That COVID-19 is a notifiable disease under the Health Protection (Notification) Regulations 2010 does not mean referral to a coroner is required by virtue of its notifiable status.



Medical practitioners are required to certify causes of death "to the best of their knowledge and belief". Without diagnostic proof, if appropriate and to avoid delay, medical practitioners can circle '2' in the MCCD ("information from post-mortem may be available later") or tick Box B on the reverse of the MCCD for ante-mortem investigations. For example, if before death the patient had symptoms typical of COVID-19 infection, but the test result has not been received, it would be satisfactory to give 'COVID-19' as the cause of death, tick Box B and then share the test result when it becomes available. In the circumstances of there being no swab, it is satisfactory to apply clinical judgement.



On the next page the document then shows an example certificate and how different circumstances should be noted:



Examples of cause of death section from MCCDs (including example of COVID-19 as underlying cause of death):

I don't disagree, but the point I'm making is that this doesn't mean that there aren't other pressures being brought to bear on doctors to avoid writing Covid-19 on the certificate unless there is a positive test result.  You can see in the entire government spin machine right now that their position is, if the person hasn't tested positive with a swab test, they don't have covid-19.  Talk to any respiritory doctor, immunologist, or epidemiologist and they'll tell you that the test has a significant false negative rate - some doctors are quoting 25%.  Now, this is partly because we are only testing mainly people who've already been sick for a week or so which is where the test becomes a lot less effective.  If we were testing people as soon as they had symptoms, it would be much more reliable.



Put simply, the fact that the official guidance says that they can put it on the death certificate, doesn't mean that they will, especially if they are coming under other covert persuasion like "oh, but there's a one in a gazillion chance that they contracted these 4 other illnesses all at the same time giving the exact same presentation etc" (even in spite of them also testing negative for some of those other illnesses as well.

[Scott777]

So, to be precise for those having trouble understanding what is going on, the ONS figure IS NOT the number of Covid-19 infected deaths.  It could be anything from 0 (or whoever was actually tested) to the official figure.

[patman post]

As I understand it, this means:

If symptoms of Covid (symptoms that are also common with colds and flu) are judged to be present, and they think it was a contributing factor (even a tiny contribution), it is marked as a Covid-19 death.  This is an entirely faulty assessment, and evidently from WHO guidelines.

If you've read the document (it's not that long) and still think it's unclear, all I can respond is a plagiarized comment from Nick: I can explain it to you, but I can't understand it for you.

[Scott777]

Reading the official guidance on completing death certificates during this period should answer all reasonable questions from sensible adults...



https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877302/guidance-for-doctors-completing-medical-certificates-of-cause-of-death-covid-19.pdf">https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877302/guidance-for-doctors-completing-medical-certificates-of-cause-of-death-covid-19.pdf

As I understand it, this means:

If symptoms of Covid (symptoms that are also common with colds and flu) are judged to be present, and they think it was a contributing factor (even a tiny contribution), it is marked as a Covid-19 death.  This is an entirely faulty assessment, and evidently from WHO guidelines.

[Thomas]

  The fact is, the whole testing procedure is at fault.  

What testing procedure?



This is one of the main arguments being played out scott , the deiberate lack of information  , testing , and the whole fog surrounding doctors being gently encouraged not to mention covid 19 on death certificates.



The uk has one of the worst testing rates in the entire world , i think it was peston  , barrys friend , who showed out of 20  states in the developed world the uk came bottom for testing . 0.5% of the population.



If the uk was actually testing a large volume of people , instead of hancock making up excuses and gove standing on tv blatantly lying about not being able to get testing kits , then we would have a much clearer picture as has been the WHO`s argument to the uk government from day one and their idiotic herd immunity strategy that patman denies they ever really considered.

[Thomas]

This doesn't appear to set out the rules very specifically as to when they can or cannot write Covid-19.

You are right javert.



Jo maugham qc made the point and i quote...



https://pbs.twimg.com/media/EVzN29OWAAIPeJn?format=png&name=small">

I read it as gently discouraging Drs from putting Covid-19 on the form at all. This bit is what I think is wrong and objectionable.

[/b]





https://twitter.com/i/status/1251059027104194562">https://twitter.com/i/status/1251059027104194562

[Scott777]

https://pbs.twimg.com/media/EV4HMrfX0AIixEC?format=jpg&name=900x900">



















https://twitter.com/C4Ciaran/status/1249787270292480000">https://twitter.com/C4Ciaran/status/1249787270292480000





Dont forget , the chinese are bad though and cant be trusted! :thup:

The truth is the opposite.  This is C4 propaganda.  What whistleblower?  The fact is, the whole testing procedure is at fault.  People are being marked with "Covid-19" based on vague information and dodgy judgement.  Many doctors are suggesting the actual cause of death is not any virus, but specifically immune deficiency which would allow a common virus to make you ill.  The reasons for this deficiency are manifold:



Lack of sunshine (vitamin D deficiency)

Lack of exercise

Junk food (such as sugar)

Smoking, alcohol, drugs

Radiation from phones, computers, etc

Air pollution



Then the lockdown itself, and fear of the virus:

Lack of socialising

Depression, anxiety



Then the treatment:

Respirators which may actually be making people worse, due to trauma and pressure on the lungs

Contagion within the hospitals, via the staff

[Thomas]

You come across as just trouble-making for the sake of it.

You cant win on this forum barry.



The other day , i simply asked john of gwent how his health was , pappy smurf derailed the thread as normal and borkie grumbled at me to talk politics.



Now im talking politics , you accuse me of trouble making as its not the sort of politics the tory faithfull want to hear. :roll:

The fault for the deaths lies in the virus, not in politics.

Dont agree. We are talking politics and comparing how governments and nations are responding to the virus globally , and the uk tory governemnt is coming under increasing criticism.



You" politically"criticised china yesterday over their death figures , and transparency , and when we do the same today about the uk government , you say we musnt talk politics and its the virus fault.

 You will do all you can to deride the government, .

of course and whats wrong with that?



More to the point over the last week if not more , there has been a growing clamour for those whose actual job it is to criticise the uk government  , for not doing that feckin job.



The likes of piers morgan , who is certainly no friend of me or mine , has received plaudits for actually  being among the few trying to hold this woefull government to account over its pathetic record on covid 19 so far.

There's only one route, protect the old and infirm as far as possible. Let the fit become immune. People die, sorry.

Dont agree with you in the slightest.



Since this began , over the last few months on this forum you have consistently made vague and oblique references in support of the "herd immunity " theory. Our last conversation on this subject was the question i asked you why is the uk government the only government in the entire developed world who was originally even considering this" infect the herd strategy and protect the vulnerable as best we can if we can" you allude to yet again above?



I even pointed out the maverick Trump ridiculed this policy , just before the tory government sent out its spokepeople and internet bots like patman post to deny all knowledge of this even being a consideration in the first place.



Now you allude to it again. Is it british exceptionalism , we know best?



You havent barely addressed any of the criticism raised on this issue.



For example you remain silent on the uk allowing 15 thousand folk a day in on london airports unchecked in any way unlike other airports i nthe developed world.3.1 miillion people through heathrow alone in march , and not one checked for coronavirus depsite many of them coming from cornonavirus hotspots.



How is this protecting the elderly and vulnerable? This is a basic dereliction of duty by the uk government  , not protecting borders.



This from the same brexiting government who were telling us to vote brexit to take back border control from brussells and uncontrolled mass immigration but cant feckin protect our borders of an island from covid 19 in even the smallest way? :roll:

[patman post]

This doesn't appear to set out the rules very specifically as to when they can or cannot write Covid-19.  ..............

To me, a non-medic, the document appears clear and unequivocal:



How to complete the cause of death section

• COVID-19 is an acceptable direct or underlying cause of death for the purposes of completing the Medical Certificate of Cause of Death

• COVID-19 is not a reason on its own to refer a death to a coroner under the Coroners and Justice Act 2009.

• That COVID-19 is a notifiable disease under the Health Protection (Notification) Regulations 2010 does not mean referral to a coroner is required by virtue of its notifiable status.



Medical practitioners are required to certify causes of death "to the best of their knowledge and belief". Without diagnostic proof, if appropriate and to avoid delay, medical practitioners can circle '2' in the MCCD ("information from post-mortem may be available later") or tick Box B on the reverse of the MCCD for ante-mortem investigations. For example, if before death the patient had symptoms typical of COVID-19 infection, but the test result has not been received, it would be satisfactory to give 'COVID-19' as the cause of death, tick Box B and then share the test result when it becomes available. In the circumstances of there being no swab, it is satisfactory to apply clinical judgement.



On the next page the document then shows an example certificate and how different circumstances should be noted:



Examples of cause of death section from MCCDs (including example of COVID-19 as underlying cause of death):

[Javert]

Reading the official guidance on completing death certificates during this period should answer all reasonable questions from sensible adults...



https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877302/guidance-for-doctors-completing-medical-certificates-of-cause-of-death-covid-19.pdf">https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877302/guidance-for-doctors-completing-medical-certificates-of-cause-of-death-covid-19.pdf

This doesn't appear to set out the rules very specifically as to when they can or cannot write Covid-19.  Of course it says that is's a valid cause of death.  However the point is that several NHS whilstleblowers have come forward to multiple organisations claiming that they are being "discouraged" from putting Covid-19 on the certificate unless there is a positive test result.  



Are you sure there isn't another document setting out, for example, additional administrative procedures to follow as and when the doctor puts Covid-19 on the death certificate?  That alone might be enough to sway incredibly busy doctors to avoid it where possible.



To me, if it's probably that Covid-19 shortened the life of the person, even if only by a short time, it should be on the death certificate either as the primary cause, or at least as a contributor.



This section is important:

You are asked to start with the immediate, direct cause

of death on line Ia, then to go back through the sequence of events or conditions that

led to death on subsequent lines, until you reach the one that started the fatal

sequence. If the certificate has been completed properly, the condition on the lowest

completed line of part I will have caused all of the conditions on the lines above it. This

initiating condition, on the lowest line of part I will usually be selected as the underlying

cause of death, following the ICD coding rules.

However the ONS is supposed to be producing regular stats of ALL deaths which mention Covid-19 anywhere on the death certificate as far as I heard the other day.

[Borchester]

If a doctor can give a reasonably certain cause of death then that is usually all that's needed. My husband had an autopsy because they didn't know. Just out of interest they don't like to reveal the report other than the result but I requested it and after some contest I did receive it.

I will be straight Toots, I know that I should agree to an autopsy and make a note in my will to that effect, but I really don't want to spend any more time in the morgue fridge than necessary. I really don't like the cold.

[T00ts]

Good stuff although it should be pointed out that while most of us oldies are grateful for the concern that society is showing us, some of us have so many other aches and pains that a bit of a cough is pretty far down our list of worries.



It does not matter a wet fart in a high wind what goes on the death certificate, although I tend to agree with Doctor Sutcliffe who, no doubt spoiled for choice when he contemplated my father's long and probably inaccurate list of medical problems, put down heart failure on the grounds that it certainly had. It certainly would not have troubled the old fellow who always enjoyed a joke.



I don't know how things stand now (perhaps Barry can look into this) and the hospitals might  be having a bit of a storage problem,  but the practice used to be for the relatives to be asked if they would agree to an autopsy,which is probably the best way to determine the cause of death. Very few people do (or did), which is a shame.

If a doctor can give a reasonably certain cause of death then that is usually all that's needed. My husband had an autopsy because they didn't know. Just out of interest they don't like to reveal the report other than the result but I requested it and after some contest I did receive it.

[Borchester]

There's only one route, protect the old and infirm as far as possible. Let the fit become immune. People die, sorry.

Good stuff although it should be pointed out that while most of us oldies are grateful for the concern that society is showing us, some of us have so many other aches and pains that a bit of a cough is pretty far down our list of worries.



It does not matter a wet fart in a high wind what goes on the death certificate, although I tend to agree with Doctor Sutcliffe who, no doubt spoiled for choice when he contemplated my father's long and probably inaccurate list of medical problems, put down heart failure on the grounds that it certainly had. It certainly would not have troubled the old fellow who always enjoyed a joke.



I don't know how things stand now (perhaps Barry can look into this) and the hospitals might  be having a bit of a storage problem, but the practice used to be for the relatives to be asked if they would agree to an autopsy, which is probably the best way to determine the cause of death. Very few people do (or did), which is a shame.

[papasmurf]

Reading the official guidance on completing death certificates should answer all reasonable questions from sensible adults...

Quite, but I am afraid as time passes during the current crisis those are getting as rare as rocking horse poo and unicorns.

[patman post]

Reading the official guidance on completing death certificates during this period should answer all reasonable questions from sensible adults...



https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877302/guidance-for-doctors-completing-medical-certificates-of-cause-of-death-covid-19.pdf">https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877302/guidance-for-doctors-completing-medical-certificates-of-cause-of-death-covid-19.pdf