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How COVID-19 deaths are counted in B.C.

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June 11, 2021 - 7:00 AM

As the B.C. death count due to COVID-19 slowly grows towards the 2,000 mark (1,725 as of June 10), the sad reality is that we will never know just how many of those deaths were caused by the virus as opposed to other ailments.

That picture is clouded not only by the fact that most deaths have been in elderly people with various other underlying conditions but also due to a new way of classifying deaths set up because of the pandemic.

Which is not to imply that there is any great inaccuracy in the total number of deaths reported.

Prior to the pandemic, all deaths were certified by an attending physician and it would take weeks or months for that data to be recorded and logged with the Vital Statistics Agency of B.C.

“With COVID, because of the large number of deaths and the need for information rapidly on deaths of COVID for public communication and for public health decision making, we instituted a public health definition that is to be used by medical health officers to be applied as soon as a case is reported or as soon as a person dies,” Dr. Eleni Galanis, a physician epidemiologist with the B.C. Centre for Disease Control’s communicable diseases and immunization service team, told

“For the vast majority of deaths in a person who was infected with COVID, if they died in that period between being diagnosed or between illness onset and recovery – which for most people is 10 days but it could be longer – then they’re automatically considered as a COVID death,” Dr. Galanis said.

An example of an exception would be a case where a person was in process of a medically assisted death when they happened to get COVID.

In the Interior Health region, former chief medical health officer Dr. Albert de Villiers has made it clear for a number of weeks that some of the more recent deaths in long term care homes, especially with residents who had been vaccinated, may have been classified as COVID deaths but may have been due to other causes.

“With some of the older people and some in long term care, there’s not always an autopsy done so we won’t ever necessarily get to what was the exact cause,” he said during a press briefing last month. “Was the cause the underlying cancer or the underlying blood condition or the age of 105? What was the underlying condition and how much COVID actually contributed, we will never know.”

That doesn’t mean there’s been any overstatement of COVID deaths in the province.

Two comparisons have been done on data compiled by both the Vital Statistics Agency – based on the bedside physician’s decision – and Public Health – based on their definition that it’s a COVID death if someone had COVID when they died.

Those comparisons found that, in 85 per cent of cases, both systems agreed that COVID was the primary cause of death.

Of the 15 per cent, some said it was COVID when it turned out it wasn’t or vice versa.

It could be, for example, that a bedside doctor certified a COVID death before a negative test result came back.

Or, a person may have had COVID but died because of the trauma caused by falling out of bed so that’s not a true COVID death.

The sampling shows a great deal of overlap so it’s not likely that anyone is ever going to go back into the system to make corrections.

“Neither the vital stats agency nor ourselves in public health have the time to do it,” Dr. Galanis said. “What we did do is compare it twice to make sure we’re aligned enough and we were both satisfied that we were aligned enough that the data is valid to make decisions on. I don’t think we’ll ever go back and correct the public health data but we will likely, in the future, when we count deaths due to COVID, we’ll use the vital statistics database.”

COVID aside, it’s not always easy to determine the exact cause of death without doing an autopsy.

“It’s really hard,” Dr. Galanis, who has personally written a number of death certificates, said. “You know the person had diabetes, they had cardiovascular diseases and they had dementia. What really killed them at the end? Well, it was a heart attack but, would they have died of a heart attack if they didn’t have the other two? So, the way the physician writes the cause of death and the order in which they put those things is variable.”

The same is true with COVID.

“Where someone is known to have chronic bronchitis and had COVID and died then, likely, I would put both,” Dr. Galanis said. “Depending on how the clinical picture developed, I might put COVID as the underlying cause of death and bronchitis as the contributing cause, or vice versa. And there’s an unlimited number of contributing causes that you can put in there. Because of the demands of the pandemic, each individual death was not specifically assessed by public health so if the person had COVID and bronchitis they would be counted within the COVID related deaths by the public health system.”

Again, the degree of accuracy in the way COVID deaths are counted is sufficient to make the accounting system acceptable, she said.

“Neither system is completely accurate but I’m personally reassured that there’s good overlap between the two which reassures me that, for the vast majority of cases – close to 85 per cent – there’s agreement which gives me confidence the data that we’re providing (Provincial Health Officer) Dr. Henry and Minister Dix is sufficiently accurate to make decisions on.”

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