Feature Article
COVID-19 AND THE MISPLACED FEAR OF DEATH! Sameera A Gunawardena Senior Lecturer and Head, Department of Forensic Medicine and Toxicology Faculty of Medicine Colombo
worldwide. Yet, despite these seemingly obvious statistics, there is growing scepticism in scientific and non-scientific fora whether these numbers provide a veritable representation of the lethality of this newly discovered virus.
ri Lanka recently surpassed an official tally of 280 deaths from COVID-19 whilst the global death toll exceeded 2 million. This figure places COVID-19 in the top six leading causes of global mortality and slightly above the annual toll of road traffic fatalities. Although this is much less than the Spanish Flu which is believed to have killed at least 20 million in the space of two years, none of the recent viral epidemics apart from two Influenza A epidemics in the mid 1950s and 1960s have recorded such staggering number of deaths. SARS n-CoV2 has therefore gained notoriety as a virus with a potentially high level of fatality far exceeding its predecessor in 2003, which recorded only 700 deaths
Non-uniformity in defining COVID-19 deaths
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10 | February 2021
The conundrum begins with the manner in which a COVID-19 death is defined. The WHO definition of a COVID-19 death reads as follows; “COVID-19 death is defined for surveillance purposes as a death resulting from a clinically compatible illness in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID-19 disease (e.g. trauma). There should be no period of complete recovery between the illness and death” This definition however, was put out much later in the course of the pandemic and countries affected by the disease in the early months of 2020 had already ad-
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opted their own definitions and strategies for reporting COVID-19 deaths. The UK (Public Health England) for example, used - “A death in a person with a laboratory-confirmed positive COVID-19 and died within 60 days of the first specimen date..” to define a COVID-19 death. Though the time frame was later reduced to 28 days, this definition still includes all deaths that have a positive laboratory test for COVID-19, regardless of the clinical state of the person during death or the cause and manner in which the death occurred. It is no surprise therefore, that UK currently has the greatest number of deaths per 100,000 population. Similarly, Belgium which reported the highest tally of deaths during the initial stages of the epidemic, expanded the WHO definition to include unconfirmed COVID-19 deaths that occurred in residential care institutions for the elderly. This broader inclusion strategy was used due to observations that a large proportion of COVID-19
