Intended for healthcare professionals

Letters Non-covid services in the pandemic

Coronial necropsies show the indirect damage from covid-19

BMJ 2021; 372 doi: (Published 24 February 2021) Cite this as: BMJ 2021;372:n529
  1. Sebastian B Lucas, emeritus professor of pathology
  1. Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
  1. sebastian.lucas{at}

The SARS-CoV-2 pandemic is impacting non-covid care to a greater extent than reducing normal in-hospital care for cancer and urgent cardiac surgery.1 It is associated with excess deaths in the community from diseases that would normally be diagnosed and treated by GPs and emergency hospital doctors. Pathologists performing medico-legal necropsies see these: Pell and colleagues identified acute myocardial infarction, diabetic ketoacidosis, alcoholism, and suicide in this category.2 I add to this list, as consequences of fear of attending hospital, falciparum malaria, venous thromboembolism, and maternal death following self-delivery at home.

Such data will not be identified from Office for National Statistics cause of death certification alone, and many of these indirect deaths from covid-19 will not be subject to an inquest. Epidemiologists must examine the detailed necropsy reports to identify and quantify these deaths as the collateral damage from the pandemic. Coroners and fiscals should be making the reports available, rather than—as at present—confidential.


  • Competing interests: None declared.

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