Reporting change to exclude some COVID-19 deaths

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This article was published 29/03/2022 (1300 days ago), so information in it may no longer be current.

Manitoba’s recent change to the way it defines COVID-19 fatalities is expected to include fewer people in the pandemic death toll.

On March 15, provincial public health officials updated criteria for a COVID-19 death to include only people who die within 30 days of testing positive for the virus, and people who test positive for COVID-19 during a post-mortem exam.

Tara Moriarty, a University of Toronto associate professor and infectious diseases expert, said the new definition excludes a proportion of Manitobans whose deaths can be tied to the disease.

The definition leaves out people who have a prolonged illness or who die due to complications from the virus, particularly those with pre-existing conditions worsened by infection, she said.

“Reporting only people who die within 30 days of COVID is really problematic,” said Moriarty, who has studied excess mortality related to the COVID-19 pandemic. “We know that there are quite a few deaths that occur longer than 30 days after someone is infected with COVID.

“Some longer term consequences of COVID, like effects on clotting, diabetes, kidney disease… those deaths may not show up right away,” she said. “So the 30 day (limit) is really tight.”

Moriarty said the 30-day limit was likely introduced to exclude deaths where a person had a history of a COVID-19 infection, but medical examiners were not entirely sure if the disease contributed to the death.

“The problem is you can’t interpret any of that until after the fact,” Moriarty said. She argued a retrospective analysis of excess deaths would more effectively flag any over or under reporting of COVID-19 fatalities.

“Most of us rarely die out of the blue from one thing. It’s usually a combination of things,” Moriarty said. “At the time of death, even clinical judgment about this is not great, you really need to look at it at a population level.”

Moriarty said the province’s new definition does hit the mark in some respects.

Previously, deaths had to result from an illness clinically compatible with COVID-19, a definition adapted from the World Health Organization. Now, Manitoba will report all deaths of people who tested positive for COVID-19 within 30 days.

The disease does not have to be the underlying cause or a contributing factor to the death and a positive laboratory test is sufficient for reporting. Moriarty said that is consistent with guidance from the WHO and the Public Health Agency of Canada.

“They’re not distinguishing between ‘with COVID’ and ‘of COVID,’” Moriarty said. “You’re really supposed to report all causes of death where COVID was present, unless it is something obvious like a trauma.”

In practise, she said the definition is unlikely to result in an inflated pandemic death toll, where people who die in car crashes or other traumatic events are counted among the fatal cases. Generally, medical examiners would have the discretion to list the cause of death, even if a COVID-19 test comes back positive post-mortem, Moriarty said.

A spokesperson for the provincial government said prior to the change, all deaths where COVID-19 was suspected were investigated and validated by public health. A request for an interview with a member of the province’s public health unit was not accommodated.

“This change is consistent with broader changes as to how COVID-19 is being managed in Manitoba, and the definition is similar to other reportable illnesses,” the province said in a statement.

There was no response to followup questions.

danielle.dasilva@freepress.mb.ca