Covid-19: “Staggering number” of extra deaths in community is not explained by covid-19
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1931 (Published 13 May 2020) Cite this as: BMJ 2020;369:m1931Read our latest coverage of the coronavirus pandemic
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Dear Editor,
I understand that the proximate medical cause may be other than Covid-19, but isn't the title a little misleading? The author surmises that lots of people died "who might have otherwise survived had they had access to a hospital". As I understand it, Covid-19 has a lot to do with why they didn't have access to the hospital: because the hospitals were overwhelmed with Covid-19 patients and considered unsafe for other patients. So it's not a stretch to say that if Covid-19 had not become a pandemic, these deaths would not have happened, in other words, the deaths are easily explained by Covid-19.
Regards,
Alexander
Competing interests: No competing interests
Dear Editor,
Can we really claim,without further investigation, that none of these excess deaths cannot be attributed to covid19? Underreporting must be suspected because lack of testing left doctors with a difficult decision :
1) As another responder points out there were early reports of GPs being reluctant to record covid19 on the death certificate https://www.dailymail.co.uk/news/article-8229169/How-elderly-Britons-car....
2) At least one hospital trust suggested pneumonia was adequate cause on a death certificate in a suspected covid-19 case .
https://inews.co.uk/news/health/coronavirus-covid-19-patients-death-cert...
Finally, The BMJ points out the low sensitivity of the RT-PCR covid-19 test which means that 30% of patients with covid-19 will test negative. This likely led to considerable underreporting of covid-19 cases?
https://www.bmj.com/content/369/bmj.m1808?utm_source=twitter&utm_medium=...
Competing interests: No competing interests
Dear Editor,
Just to reflect that a while ago in discussion of this topic in the BMJ I recall a GP commenting on guidance being issued that made it less likely to include covid19 in causes of death in the absence of testing. He further commented along the lines of this made his completion of the paperwork far less onerous admin-wise.
Think a key point to consider is that this Death certification is in the community, including care home settings where & when testing was unavailable. Given the significant extent & involvement of co-morbidities in the elderly vulnerable in particular, a GP can be in a place of some uncertainty when deciding cause of death in these circumstances.
Competing interests: No competing interests
Re: Covid-19: “Staggering number” of extra deaths in community is not explained by covid-19
Why are we assuming that these deaths occurred because patients could not reach a hospital? If we are insinuating that these deaths occurred because hospitals are overrun with COVID patients then this is simply not true. The closure of the Nightingale hospitals provides some evidence for this.
Further, correlation does not necessarily imply causation. If it were true that these deaths would not have occurred had these patients reached a hospital, then we have found a correlation, not a causation. One cannot conclude that lack of a hospital causes death. The underlying health problem caused the death. Which then leads us to ask the question, what triggered the underlying health problem to gain enough strength to result in a death?
Competing interests: No competing interests