COVID-19 fatality reporting explained

Hays County has reported 51 COVID-19 related fatalities over the course of the six months that the disease has swept through the community. 

There have been many critiques and questions about how COVID-19 related fatalities are reported and how preexisting conditions are taken into account.

Director of Countywide Operations Tammy Crumley attempted to explain in Tuesday’s Hays County Commissioners Court meeting and said it largely has to do with whether the condition for which they came to the hospital was initiated by COVID-19. 

“When it comes to deaths, physicians who treat the patients determine if the cause of death is COVID-related or not,” said Nikela Pradier, CHRISTUS Santa Rosa Hospital representative.

Hays County Epidemiologist Eric Schneider said if COVID-19 is listed on a death certificate as a cause of death, then it is reported to the local authority as such. 

“There is confusion because patients with COVID-19 may ultimately succumb for different reasons — cardiac issue, pneumonia/respiratory failure, pulmonary embolism/blood clots — but the underlying cause of death is still COVID-19,” said Dr. Manish Naik, chief medical information officer at Austin Regional Clinic.

The Centers for Disease Control says mortality data is compiled in accordance with World Health Organization regulations which says a death due to COVID-19 is a death resulting from “compatible illness,” someone who presents with typical symptoms of COVID-19. 

Naik explains before testing was widely available and before doctors knew much about the virus, someone with severe pneumonia would be presumed to have COVID-19, now COVID-19 diagnoses are confirmed with testing before being listed on the death certificate.

“Ultimately patients die because something happens in their body to stop their heart from beating, regardless of underlying conditions,” Naik said. Death certificates list the immediate reason first, whether they stopped breathing or their heart stopped, followed by underlying conditions like heart disease, blood clotting, or COVID-19. 

“The underlying condition is the real reason that the patient dies,” said Naik. “When somebody dies of cancer, they die because their heart stopped beating, but it's important to understand that the underlying condition is what led to the patient passing.” This person’s death certificate would first list cardiac arrest and then cancer as causes of death. 

Obesity, diabetes, heart disease, COPD and other preexisting conditions are known to increase the likelihood of someone getting a more severe or potentially fatal case of the disease should they become infected with COVID-19. These conditions will contribute to their death should they get COVID-19, but the underlying cause is COVID-19.

“That person with COPD didn’t die because they had COPD, they died because they had COPD and got infected with COVID-19. COVID-19 is the underlying cause.” said Naik. 

Naik says with most diseases and medical conditions that are out there, there are factors that increase risk of disease and fatality. A family history of high cholesterol increases an individual’s risk of getting heart disease, but should they die of a heart attack, it's the heart attack that killed them, not the risk factor of family history.

“If you develop COVID-19, your risk factors for a severe case are diabetes and heart disease, but those are not the reason you died,” said Naik. “The reason you died is because you had a viral infection.” 

The only instances in which a death of someone who had COVID-19 would not be listed as a cause of death and reported to the local health authority would be is there is a clear alternative cause of death such as a car accident or other trauma, or if the individual had completely recovered from COVID-19 before the time of death. 

Naik says at this point in the fight against COVID-19 there are very reliable ways to determine if COVID-19 is an underlying cause of death. “I don’t have a great deal of concern about the accuracy of the number of deaths,” he said, “If somebody puts COVID-19 on a death certificate today it's because they tested positive and have signs and symptoms of the disease. I think the data is pretty accurate.”

County Judge Ruben Becerra said that the way COVID-19 deaths are reported is not taken lightly and is subject to many audits.