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

The Regional District of Nanaimo plans to make its operations more efficient as it works on long-term goals around carbon-neutrality. (PQB News file photo)
Regional District of Nanaimo works to become carbon neutral by 2032

RDN committee of the whole members endorse plan developed by consultant

The Millstone River in Nanaimo. (News Bulletin file photo)
Regional district looks at value of Nanaimo’s natural assets

Report focused on the Millstone River could inform future decisions on corporate asset management

Protesters gather along the Pearson Bridge on Terminal Avenue in downtown Nanaimo last month as part of an event called Worth More Standing. (News Bulletin file photo)
LETTER TO THE EDITOR: B.C. hasn’t managed forests properly

Protesters opposing logging in Fairy Creek speak for many British Columbians, say letter writers

Nanaimo singer Victoria Vaughn recently released an EP with local producer Austin Penner. (Photo courtesy Taylor Murray)
Nanaimo singer and recent VIU grad releases EP about becoming an adult

Victoria Vaughn’s ‘Growing Pains’ recorded with local producer Austin Penner

The B.C. Centre for Disease Control has listed Harbour Air and Air Canada flights to and from Nanaimo, from April 3, 4 and 12, on its list of flights with COVID-19. (News Bulletin file)
COVID-19 cases reported for Air Canada, Harbour Air flights, says disease control centre

Nanaimo flights for April 3, 4 and 12 listed on BCCDC’s list of flights with COVID-19

Pat Kauwell, a semi-retired construction manager, lives in his fifth-wheel trailer on Maxey Road because that’s what he can afford on his pension, but a Regional District of Nanaimo bylaw prohibits using RVs as permanent dwellings, leaving Kauwell and others like him with few affordable housing options. (Chris Bush/News Bulletin)
Housing crunch or not, it’s illegal to live in an RV in Nanaimo

Regional District of Nanaimo bylaw forcing pensioner to move RV he calls home off private farm land

People are shown at a COVID-19 vaccination site in Montreal, Sunday, April 18, 2021, as the COVID-19 pandemic continues in Canada and around the world. THE CANADIAN PRESS/Graham Hughes
Nothing stopping provinces from offering AstraZeneca vaccine to all adults: Hajdu

Health Canada has licensed the AstraZeneca shot for use in people over the age of 18

Deputy Prime Minister and Minister of Finance Chrystia Freeland responds to a question during Question Period in the House of Commons Tuesday December 8, 2020 in Ottawa. The stage is set for arguably the most important federal budget in recent memory, as the Liberal government prepares to unveil its plan for Canada’s post-pandemic recovery even as a third wave of COVID-19 rages across the country. THE CANADIAN PRESS/Adrian Wyld
Election reticence expected to temper political battle over federal budget

Opposition parties have laid out their own demands in the weeks leading up to the budget

Noel Brown, Snuneymuxw First Nation carver, observes the house post he carved, which now is situated in front of the Kw’umut Lelum centre on Centre Street in Nanaimo. (Karl Yu/News Bulletin)
House post representative of work of Kw’umut Lelum in Nanaimo

Snuneymuxw First Nation artist Noel Brown’s carved red cedar house post unveiled Friday, April 16

(Black Press file photo).
UPDATED: Multiple stabbings at Vancouver Island bush party

Three youths hospitalized after an assault in Comox

A syringe is loaded with COVID-19 vaccine at a vaccination clinic run by Vancouver Coastal Health, in Richmond, B.C., Saturday, April 10, 2021. THE CANADIAN PRESS/Jonathan Hayward
B.C. to open up COVID vaccine registration to all B.C. residents 18+ in April

Registration does not equate to being able to book an appointment

Russ Ball (left) and some of the team show off the specimen after they were able to remove it Friday. Photo supplied
Courtenay fossil hunter finds ancient turtle on local river

The specimen will now make its home at the Royal BC Museum

Selina Robinson is shown in Coquitlam, B.C., on Friday November 17, 2017. British Columbia’s finance minister says her professional training as a family therapist helped her develop the New Democrat government’s first budget during the COVID-19 pandemic, which she will table Tuesday. THE CANADIAN PRESS/Darryl Dyck
B.C. finance minister to table historic pandemic-challenged deficit budget

Budget aims to take care of people during pandemic while preparing for post-COVID-19 recovery, Robinson said

Most Read