last week, some Western media have accused Russia of concealing the true number of deaths. Tatyana Golikova has denied the charges, explaining that “any fraud we don’t do”. However, the dead we have really very little – less than a percent of the total number of cases, despite the fact that in Spain, the UK, France, this figure reaches 12-14%, and in the USA up to 6%. We found out why there was such a stark contrast.
Who is considered to be dead from coronavirus, who – from related diseases?
how to answer this question in a particular country depends on its statistics of deaths from the coronavirus.
In Russia the cause of death of people trapped in the hospital with a new infection, establish pathologists.
the Procedure for establishing the cause of death is determined Temporary methodical recommendations of the Ministry of health of April 28, 2020 – Chapter 8 “the Order of carrying out of pathoanatomical autopsies”.
to quote from this document – it is long, but explains a lot.
“Postmortem (approx. it is everyone treated in the hospital from coronaviruses infection) carried out in the presence of a professional organization authorized to exercise Federal state sanitary-and-epidemiologic supervision (approx. is CPS).
the Autopsy conducts or supervises head of/ most experienced pathologist.
an Autopsy should be conducted as early as possible time. Autopsy material (a piece of lung, and clinical and other bodies) in the shortest time sent to FBUZ “Center of hygiene and epidemiologii” in subjects of the Russian Federation on the presence of COVID-19, and other viral and bacterial pathogens of respiratory infections.
Final anatomopathological diagnosis is formulated after histological investigation and receipt of laboratory results.
In the formulation of pathoanatomical diagnosis should be differentiated:
1) death from COVID-19 when COVID-19 is the primary disease (underlying cause of death);
2) death from other diseases in the presence COVID-19 (diagnosed using the methods of amplification of nucleic acids), but without the clinical-morphological manifestations, which could be the cause of death.
the Most common complication COVID-19 is ARDS (approx. – acute respiratory distress syndrome).
in addition, was these complications that also can be considered as the immediate cause of death:
Acute heart failure
Acute renal failure;
Septic shOK;
ice (approx. syndrome of disseminated venturacountystar blood clotting);
multiple Organ failure (impaired functions of many organs and systems);
Secondary bacterial and fungal infections”.
To understand the Russian method of counting deaths from coronavirus, the key is the last paragraph: “the complications that can be treated as the proximate cause of death.”
it implies that coronavirus infection recorded in the postmortem diagnosis as the cause of death only if the person died from respiratory arrest and he had positive in vivo test.
But if his heart stopped before respiratory failure, the underlying cause of death can be determined as, for example, “congestive heart failure”, and coronavirus infection appear as a concomitant disease.
Accordingly in the national statistics this person adds to the list of deaths from cardiovascular disease and not from the coronavirus. In his certificate of death kovid will be mentioned, but under “other significant condition contributing to death but not related to the disease or pathological condition leading to it.”
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Most countries follow a different procedure.
first, they have no CPS, whose members are watching all the autopsies.
secondly, the very opening is almost never mandatory, and in some countries, for example, Sweden, died of coronavirus and it is prohibited because of the risk of infection for patologoanatom.
it is believed that an autopsy is not necessary if the patient was in the hospital. If he died at home, or if he was only brought to the hospital, and he died instantly, then Yes, an autopsy is needed to understand how he died. But if was in the hospital, and the story of his illness is described, the cause of death determined by a physician in the clinical picture.
In the statistics of deaths from the coronavirus in Western countries typically include all deaths in hospital patients who had a positive test and the corresponding clinical picture (pneumonia), with the exception of those who had tested positive, but still he died absolutely unrelated coronavirus woes – from traumatic brain injury, for example.
In some countries – for example, Belgium – includes those with a positive test was not, but was suspected by infection with a coronavirus. So the stats shows there is a high mortality rate.
In Italy for this reason, on 30 March there were more than 10 thousand deaths per 97 thousand patients. Mortality got about 10%. Very high.
the Immediate cause of death coronavirus it was also mentioned whethernil in 12% of cases – last week about it reported Advisor to the Ministry of health, Italy Walter Richard.
But remember, it’s all about the people who died in the hospital. People were observed by doctors. Had a reliable history of the disease.
the Cause of death of one who died not in hospital, to determine without an autopsy it is impossible. But where the pandemic is rampant, autopsies are not carried out, since the pathological case is at appropriate facilities. As a result, these deaths do not fall into coronavirus statistics, but join the “excess” mortality. So, for example, happened in Ecuador, where people did not take to hospital because they do not have seats.
In the period from 1 March to 15 April in Ecuador recorded a huge “excess” deaths: died on the 7600 more than die on the average. Although according to official data from the coronavirus killed only 500 people.
as for the USA is inexplicable “excess” death rate there is also high: if Moscow in April she is about 1,400 employees not included in the statistics of deaths from the coronavirus in new York of these deaths, almost 4,000.
how to explain it – is not clear. In new York the corpses in the streets was not lying. Perhaps some of these 4000 “excess” deceased died outside of hospitals, and autopsy were not performed, therefore cowed as the cause of their death was not recorded, and they are not included in the statistics.
We have studied the user National center for health statistics USA, which explains how American doctors should be coded death from coronavirus infection of or in connection with it.
According to the American rules, fatal is encoded as coronavirus, when COVID-19 is the main reason which led eventually to death.
“Pneumonia, for example, is not the main cause of death, and the intermediate, because it can be caused by many infections, and inhalation of liquids or chemicals, – explained in the manual. – It is marked in the death certificate, but usually not as a main one. The main cause of death is what caused the pneumonia, in particular, COVID-19”.
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the world health Organization (who) has also issued guidelines for the identity and classification (coding) COVID-19 as the cause of death.
In section 2: “Determination of lethal outcome associated with COVID-19” is explained in detail how to decide who died from kovida, who is not from kovida.
“Death due COVID-19 is determined for control purposes as a death resulting from the disease, clinically similar COVID-19, as in the case of suspected COVID-19, and in a confirmed case, if there is no clear alternative cause of death that cannot be associated with the disease COVID (e.g., injury). There should be no period of complete recovery from COVID-19 between illness and death. Death from COVID-19 can not be attributed to another disease (e.g., cancer) and must be considered death from COVID-19 regardless of pre-existing conditions that can cause severe COVID-19”.
as an illustration, who leads card certificate of death, completed correctly and incorrectly.
for example, a card that describes the cause of death in the case of a positive test kovid.
the bottom line is written: COVID-19 (positive test). It is in the bottom – because of the infected with kovida started everything else that is described in the lines above. The test was positive 14 days before death. It led to pneumonia. The deceased was ill with pneumonia 10 days, it led to acute respiratory distress syndrome (ARDS), in which two days later death occurred.
the Immediate cause of death was ARDS. But who recommends to code it as death by COVID-19, because he “is the basis” of death.
an Example of a certificate who, on the death of the coronavirus.
here is an example of the death certificate of a man who was also infected with coronavirus. But he got in dorozhno-transport incident. The next day was dissection of the aorta and hypovolemic shock. He died. The immediate cause of death was blood loss. And the reason, “the underlying” death is, according to who, an accident. Coronavirus, which was the infected person, as specified in paragraph 2: “Other relevant circumstances”.
an Example of a certificate who, on the death from the coronavirus.
In principle, the who recommends to determine how the death of coronavirus, which are based on the infection COVID-19, even if the immediate cause of death was not respiratory failure, and exacerbation of chronic diseases leading to death was cardiac arrest, renal failure, sepsis, thrombosis, etc.
But what’s important. These rules are called the only true from a medical point of view.
who asks to follow them, not because they are undeniable, and because for maintaining the correct global statistics required uniform in all countries, the approach to determining the cause of death, as death from coronavirus. Only then the data across countries it will be possible to compare, to draw conclusions, to calculate the average death rate, to find out whether it depends on genetics, climate, vaccination against tuberculosis, etc.
“the Task of the classification (coding) of mortality is most useful in compiling statistics of causes of death, – it is noted in the who recommendations. As a result, our instructions must be applied regardless of whether they are from a medical point of view. Individual countries should not adjust their data that they seem incorrect, as in this case, the data of one country is incorrect to compare with data from other countries, and therefore it will be less useful for analysis.”
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If you go back to the beginning of this article and re-read the Provisional recommendations of the Ministry of health, you will notice that they are contrary to who recommendations.
the who recommends that all coronavirus death, based on the infection COVID-19, regardless of the immediate cause of death and results of in vivo test for the coronavirus.
And Temporary recommendations of the Ministry of health allow us to qualify the immediate cause of death, occurring due to exacerbation of chronic diseases as the main, and require the presence in vivo of a positive test.
Which approach is more correct from a medical point of view?
Opinions vary. Moreover, not only among Russian physicians. The same Walter Richardi, Advisor, Ministry of health of Italy, said recently in an interview that die with the coronavirus and die from coronavirus is not the same thing.
the Chief pathologist of the Ministry of health George Frank is also strongly opposed in order to explain the death of patients with early stages of this disease. “In some cases COVID-19 may be the main cause of death of the person, and in some cases it can be just the background of the disease, sometimes even accompanying disease, if it is poorly flowing, and the person has some other serious illness. If a person has cancer of the stomach with metastases and thus easy form COVID-19, it is natural in the first place is stomach cancer, which leads the patient to death.”
the Logic in this argument is certainly there.
the Bad thing is that we keep this logic out of step.
Other countries make their statistics more or less in accordance with who recommendations, and we go our own way. Because of this, our statistics of deaths looks better than in other countries, raising suspicions against Russia and accusations of fraud.
the Western media, however, already kind of realized that too far. Yesterday Agency Bloomberg has changed the bloodthirsty title of his article “Experts want to know why the coronavirus killed more Russian” in a more discreet – “Experts question about Russian data on mortality from COVID-19”.
Though to ask, nothing special. Take the Provisional recommendations of the Ministry of health, read about the procedure autopsy, about the participation of Rospotrebnadzor, the formulation of the diagnosis – and all will become clear soon.
by the Way, there is another interesting point – but not for foreigners and for Russians.
As established by the Provisional recommendations of the Ministry of health, “final anatomopathological diagnosis is formulated onafter complete histological examination and receipt of laboratory results”.
However, an autopsy is not always possible to spend a day of death.
FBUZ “Center of hygiene and epidemiology”, which need to get taken during the autopsy for research materials, there is not in every city.
and the very histological examination – not a quick process, it takes several days.
So when morning published fresh statistics on the coronavirus, and it indicates the number of new deaths from kovida, we need to keep in mind that this is not the day before they died, and at least 5 days ago.
Of those who really died yesterday, nobody knows and can not know, besides family, of course.
Our condolences to them. And the dead – blessed memory.
