Coronavirus

[Mike T]

Yes. When my father died I expressed a wish about the cause of death to be recorded on the certificate and the Doctor was very understanding; and my mother and I were very grateful.

There will probably have been multiple possible certifications that fulfilled that requirement. Which risk factors were mentioned/left out? The same applies to contributing factors.

Take a fatal heart attack. You cannot just say cardiac failure, but you can if you qualify it with a cause, such as coronary artery disease. That is all you need, but you could add cigarettes/diabetes/obesity/high cholesterol, or you could leave all those out, or just mention some of them.

And Covid increases the risk of clots in the legs/lungs (DVT/PE), cardiac inflammation and rhythm problems, strokes, lung inflammation and pneumonia and so on - and these do not necessarily occur only during the initial acute stage. So when do you put Covid on the certificate, and when do you leave it out? And if you include it, and let the Coroner know, what does he say? And if you decline to do a certificate, will the Coroner just do the certificate himself - including/leaving out Covid? Or will he hold an inquest?
So many possible variations, so many possible opinions - differences do not necessarily mean deceit, yet all these differences will add up. Hence my wish to see the full Covid numbers, not just the 28 day numbers.

[Mike T]

For light reading - paras 17 to 23 are the relevant ones - as you will see there is lots of leeway, lots of may/might/should etc:

https://www.judiciary.uk/wp-content/...arch_2020-.pdf

[Mike T]

Move along, nothing to see here ....

https://www.theguardian.com/world/20...cial-interests

[Witton Park]

https://www.telegraph.co.uk/news/202...ly-cost-lives/

For those who cannot see it due to paywall here is most of it.

The British public protected the NHS alright. Any fears that the institution might be overwhelmed were put aside when, a couple of weeks into lockdown, the hurriedly-constructed Nightingale hospitals were still empty, along with many other hospital wards, clinics and surgeries. By mid April, routine clinical activity by GPs was down 25 per cent and A&E visits down 52 per cent.

A month ago, the Department for Health and Social Care (DHSC) quietly published an analysis which came to the stark conclusion that lockdown could end up costing more lives than the virus.

The study, which estimated loss of life in terms of Quality-Adjusted Life-Years (QALYs), calculated that Covid-19 will cost 530,000 QALYs in the year to March 2021. On the other side of the ledger, however, reduced access to A&E in that time could cost 41,000 QALYs and the early discharge of some patients from hospital in order to make way for the expected wave of Covid patients a further 73,000 QALYs. In the longer term, the cancelling and postponement of surgery and other treatments will cost 45,000 QALYs, the recession 157,000 QALYs and the long term effects of poverty due to a smaller economy 294,000 QALYs.

The department still said that it thought lockdown had been worth it, on the grounds that it helped save many more lives from Covid-19. Nevertheless, the report concluded, “when morbidity is taken into account, the estimates for the health impacts from a lockown and lockdown-induced recession are greater in terms of QALYs than the direct Covid-19 deaths.”

We should be wary of any such modelling, but there is little doubt that cancers have gone undetected and heart attacks untreated. Even by June, when the number of Covid patients had dropped sharply and the country was opening up again, the NHS was still running at half-cock. In that month, GPs made 153,134 urgent cancer referrals, 21 per cent down on June 2019. Routine hospital treatments were down 67 per cent. The legacy of lockdown, according to a study by healthcare technology company Medefer, is that there are 15.3 million people waiting for an NHS appointment. There are 50,536 who have been waiting for more than a year – up from 1,643 in January.

We all know the modelling which led to the country being locked-down: Professor Neil Ferguson’s paper claiming that 500,000 people could die in Britain of Covid-19 unless the Government took drastic action. But how much consideration was put into the negative effects of lockdown on our health? Ministers seem to have been terrified by a big scary number spewed out by a mathematical model, without it ever occurring to them that there was another other scary number crying out to be estimated: the number of people who would lose their lives as a direct or indirect result of trying to “protect the NHS”.

The Government had no idea of the costs of lockdown on the nation’s health because it never countenanced that course of action. Its pre-Covid pandemic plans sought to prepare for an infectious disease which would be caught by 50 per cent of the UK population and kill up to 2.5 per cent of those it infected, with a possible death toll of 750,000 – worse even than Ferguson’s worst-case scenario. Yet lockdown was never part of the plan: people were to be encouraged to go about their daily business in as normal a way as possible.

But come Covid and all that went out of the window. We were ordered indoors and told not to bother the NHS unless we were seriously ill – all without any consideration of what that would mean for heart patients, cancer patients and anyone else who fell ill of anything other than Covid-19. The NHS was reconfigured as a National Covid Service which needed “protecting” from anyone suffering from anything else. I had always thought that the NHS was supposed to be there to protect us.

In the comments section I came across this.
The NHS is there to cure the sick, regardless of what they are sick from, not as an end in itself that needs to be protected from sick people in case it gets overwhelmed. It is seemingly unable to dynamically manage capacity and resources week by week or day by day. It is sacrilege to criticise it or even begin a constructive conversation about running it better. We must be pathetically grateful it exists even if we are not allowed near it. And, now, many hospitals are half empty and staff are twiddling their thumbs. It is like having an enormous, incredibly expensive library where the books cannot be read in case they get damaged.

[Dave_Mole]

Thanks Mike T for your thoughtful and considered comments.

[Dave_Mole]

And here's the conclusion of an update to the report cited in the Telegraph.

"While these negative health impacts of lockdown exceed the impacts of COVID-19 directly, they are much smaller than the negative impacts estimated for a scenario in which these measures are not in place; without these mitigations, the impact of direct COVID-19 deaths alone on both mortality and morbidity would be much higher".

https://www.ons.gov.uk/news/statemen...tyandmorbidity

[Witton Park]

There will probably have been multiple possible certifications that fulfilled that requirement. Which risk factors were mentioned/left out? The same applies to contributing factors.

Take a fatal heart attack. You cannot just say cardiac failure, but you can if you qualify it with a cause, such as coronary artery disease. That is all you need, but you could add cigarettes/diabetes/obesity/high cholesterol, or you could leave all those out, or just mention some of them.

And Covid increases the risk of clots in the legs/lungs (DVT/PE), cardiac inflammation and rhythm problems, strokes, lung inflammation and pneumonia and so on - and these do not necessarily occur only during the initial acute stage. So when do you put Covid on the certificate, and when do you leave it out? And if you include it, and let the Coroner know, what does he say? And if you decline to do a certificate, will the Coroner just do the certificate himself - including/leaving out Covid? Or will he hold an inquest?
So many possible variations, so many possible opinions - differences do not necessarily mean deceit, yet all these differences will add up. Hence my wish to see the full Covid numbers, not just the 28 day numbers.

I'm surprised you could mention cigarettes. Cigarettes / smoking aren't a condition even if they are a contributory factor, because otherwise you could go back in to someone's life in real detail.

For example if someone committed suicide, I'd expect perhaps overdose of cocodamol (for example) but not "following earlier loss of spouse".

It would seem a a step farther than was appropriate for a death ecrtificate.

[anthonykay]

With regard to the Daily Telegraph article posted by WP: rather than comparing QALYs lost due to Covid with those lost due to Lockdown, we need to compare total QALYs lost (Covid + Lockdown) with the total QALYs lost if a different policy had been followed (e.g. Sweden's light touch). If the other policy would have resulted in very few deaths due to Lockdown but a far greater number due to Covid, with an overall total greater than we have actually had, then the present policy is correct.

Of course, the problem is that no-one knows what the QALYs lost due to some other notional policy would be.

[Edit: I see that Dave Mole has just made the same point more succinctly (#2016) while I was writing my post.]

[Dave_Mole]

It's not me, just the updated ONS report which came out a few weeks ago. How unlike the Telegraph to use superceded data in order to have a rant....

[Graham Breeze]

For example if someone committed suicide, I'd expect perhaps overdose of cocodamol (for example) but not "following earlier loss of spouse".

Death Certificates are completed by trained and experienced Doctors exercising judgement,discretion & etc. There can be a range of wording and I suspect from the same case notes any six doctors might not produce exactly the same words; but that is because they are humans and not a computer.

I am happy with that.