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

Old English design elements can be seen in the sign of the Summerland Farm and Garden Centre in 1993. The guidelines are no longer in place, but some downtown businesses still show aspects of the days when Summerland had a theme in place. This photo was taken by Summerland photographer Dan Dorotich. (Photo courtesy of the Summerland Museum)
Summerland’s Old English theme has been abandoned

From the 1980s until the early 2000s, Summerland had design guidelines in its downtown

Penticton bylaw officers tore down a “pretty significantly sized” homeless camp underneath the bridge near Riverside Drive Friday, April 16 morning. (Brennan Phillips - Western News)
Penticton bylaw tears down ‘significantly sized’ homeless camp under bridge

Many residents had made complaints about the camp before it was torn down

Through their Simple Generosity campaign, Valley First has pledged to donate $1 million of community support to British Columbia communities in 2021. (Contributed)
Valley First rewarding Penticton families with innovative way to thrive together

Participants with ‘inspiring ideas’ will receive a surprise for their family, valued at up to $2,500

Elvira D’Angelo, 92, waits to receive her COVID-19 vaccination shot at a clinic in Montreal, Sunday, March 7, 2021, as the COVID-19 pandemic continues in Canada and around the world. THE CANADIAN PRESS/Graham Hughes
110 new cases of COVID-19 in Interior Health

Provincial health officers announced 1,005 new cases throughout B.C.

Ryan Upson’s first BCHL hat-trick propelled the Vees to a 7-1 stomping of the Cranbrook Bucks Thursday April 16) night to improve their record to 7-1-0-0 in this abbreviated pod season. (Cherie Morgan/Cherie Morgan Photography)
Pentiton Vees bounce back with big win over Bucks

Vees score five in under five minutes, win 7-1 over Cranbrook

Flow Academy is located at 1511 Sutherland Avenue in Kelowna. (Michael Rodriguez - Capital News)
Black Press Media Weekly Roundup: Top headlines this week

Here’s a quick roundup of the stories that made headlines across the Okanagan, from April 11 to 16

B.C. Health Minister Adrian Dix and Premier John Horgan describe vaccine rollout at the legislature, March 29, 2021. (B.C. government)
B.C. health minister says delay in Moderna vaccine ‘disappointing’

‘The sooner we get vaccines in people’s arms the better, and inconsistency in delivery is a consistent problem. This is simply a reality and not an issue of blame,’ Adrian Dix said Friday

(Police handout/Kamloops RCMP)
B.C. man dies in custody awaiting trial for Valentine’s Day robbery, kidnapping spree

Robert James Rennie, who was on the Kamloops RCMP’s most wanted list, passed away at the North Fraser Pretrial Centre in Coquitlam

Photos of Vancouver Canucks players are pictured outside the closed box office of Rogers Arena in downtown Vancouver Thursday, April 8, 2021. THE CANADIAN PRESS/Jonathan Hayward
Canucks games against Leafs postponed as team returns from COVID-19

The team has had 11 games postponed since an outbreak late last month

Danita Bilozaze and her daughter Dani in Comox. Photo by Karen McKinnon
Island woman makes historic name change for truth and reconciliation

Becomes first person in Canada to be issued new passport under the TRC Calls to Action

Vancouver Police Const. Deepak Sood is under review by the Independent Investigations Office of B.C. after making comments to a harm reduction advocate Sunday, April 11. (Screen grab)
VIDEO: Vancouver officer convicted of uttering threats under watchdog review again

Const. Deepak Sood was recorded Sunday saying ‘I’ll smack you’ and ‘go back to selling drugs’ to a harm reduction advocate

Provincial health officer Dr. Bonnie Henry prepares a daily update on the coronavirus pandemic, April 21, 2020. (B.C. Government)
B.C.’s COVID-19 infection rate persists, 1,005 new cases Friday

Hospitalization up to 425, six more virus-related deaths

Ford F-350s have been targeted in the North Okanagan by auto thieves since February 2021, Vernon North Okanagan RCMP data shows. (Gene J. Puskar - The Canadian Press/AP file)
Auto thieves target older Ford F-350s in Vernon: RCMP

Vernon Mounties remind all motorists no vehicle is immune to auto crime

The Nautical Dog Cafe at Skaha marina is getting its patio ready in hopes Mother Nature will provide where provincial restrictions have taken away indoor dining. (Facebook)
‘A lot of instability’: B.C. restaurants in layoff limbo

As COVID-19 cases stay high, restaurants in British Columbia are closed to indoor dining

Most Read