Re: Doctors’ deaths from covid-19 should be reported to the coroner
It is important to ensure that healthcare workers are not sent to work in a highly dangerous environment without adequate protection. It follows that, if they are, those responsible for failing to ensure adequate protection can be held to account.
In ensuring such accountability, a first stage has to be to identify those occasions in which somebody comes to harm as a result.
This requires notification of cases. Covid-19 is a statutorily notifiable disease. Notification of all notifiable diseases is done so that public health action can (if necessary) be undertaken; and therefore has to be done promptly, on suspicion, without awaiting confirmation. (If an alternative diagnosis is subsequently made, the diagnosis can be denotified.)
Note that RT-PCR testing is only about 70% sensitive if undertaken between the time when a patient becomes infectious (typically 24-48 hours before symptom onset) and 5 days after the onset of symptoms. This means that three in every ten cases will be missed by the test: illness typical of Covid-19, in a patient who has been exposed to an infectious case should be considered to be Covid-19 until proven otherwise; and a negative PCR test does not comprise such proof. (It is also insufficient to permit such a person to return to work where they may put colleagues or vulnerable patients at risk, so testing has little value for this purpose - although systematic testing of asymptomatic staff might give an indication of the prevalence of disease in such staff).
Any harm or near misses in an occupational setting must be reported to the Health and Safety Executive HSE via RIDDOR - notwithstanding the HSE website inappropriately attempting to put people off notifications re Covid-19 unless they are both proven cases and proven to have occurred at work. If the rates in people in certain occupations are greater than in the general population, that in itself is important information; and the HSE is in dereliction of its duties if it fails to identify and investigate this.
Any deaths in which Covid-19 is considered to be a cause of death should have this recorded on the death certificate (the medical certificate of the cause of death (MCCD)).
I note that since Prof Agius' letter was published, the Chief Coroner has published further advice, in which he emphasises and reiterates that if the registered medical practitioner completing a death certificate "suspects that the person’s death was due to… an injury or disease attributable to any employment held during the person’s lifetime" they must report the death to the coroner. It doesn't say that they "should consider" doing so, or "but only if it's been confirmed...". It says that "there MUST be a report to the coroner if the medical practitioner completing the Medical Certificate of Cause of Death suspects…" (my emphasis).
It is true that coroners are advised against exploring whether governmental policies are incorrect; but they are expected to investigate if it seems possible that "some human failure contributed to the person being infected with the virus… [and they] may need to consider whether any failures of precautions in a particular workplace caused the deceased to contract the virus and so contributed to death".
Coroners have scope to decide whether or not to hold an inquest but, the Chief Coroner emphasised: "A death must be investigated and must usually be the subject of an inquest if the coroner has “reason to suspect that… the deceased died… [an] unnatural death”. In this context, the words “reason to suspect” reflect a low threshold test; lower even than a prima facie case and requiring only grounds for surmise."
So it seems that doctors are legally obliged to report all Covid-19 deaths where the deceased's occupation may have contributed to their becoming infected (which must surely apply to all healthcare workers who have been exposed to Covid-19 patients at work, as well as to other workers in public-facing roles who are likely to have acquired the infection at work - such as the bus drivers who died); and they should do so with every confidence that the coroner must, at the very least give serious consideration to holding an inquest.
There has been much discussion on the difficulty of ascertaining the case- and death rates from Covid-19. In the long run, we'll get the best idea from excess deaths. In the meantime, doctors should do all they can by clearly recording all suspected cases and deaths.
1. Agius RM. Doctors’ deaths from covid-19 should be reported to the coroner. BMJ 2020;369:m1622, DOI: 10.1136/bmj.m1622 (https://www.bmj.com/content/369/bmj.m1622 or https://www.bmj.com/content/bmj/369/bmj.m1622.full.pdf).
2. Lucraft M. Chief coroner’s guidance no. 37: Covid-19 deaths and possible exposure in the workplace: Chief Coroner's Office, 2020(28 Apr); 1-3 (https://www.serjeantsinn.com/wp-content/uploads/2020/04/Chief-Coroners-G... or via https://www.judiciary.uk/related-offices-and-bodies/office-chief-coroner...).
Competing interests: No competing interests