Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Dying ‘due to’ or ‘with’ COVID-19: a cause of death analysis in hospitalised patients

Thomas A Slater, Sam Straw, Michael Drozd, Stephe Kamalathasan, Alice Cowley and Klaus K Witte
Download PDF
DOI: https://doi.org/10.7861/clinmed.2020-0440
Clin Med September 2020
Thomas A Slater
AUniversity of Leeds, Leeds, UK
Roles: clinical research fellow
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sam Straw
AUniversity of Leeds, Leeds, UK
Roles: clinical research fellow
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael Drozd
AUniversity of Leeds, Leeds, UK
Roles: clinical research fellow
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Stephe Kamalathasan
BLeeds General Infirmary, Leeds, UK
Roles: clinical fellow
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alice Cowley
BLeeds General Infirmary, Leeds, UK
Roles: clinical fellow
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Klaus K Witte
CUniversity of Leeds, Leeds, UK and consultant cardiologist, Leeds General Infirmary, Leeds, UK
Roles: associate professor
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: k.k.witte@leeds.ac.uk
  • Article
  • Figures & Data
  • Info & Metrics
Loading

ABSTRACT

The SARS-CoV-2 pandemic is accompanied by an ever-rising death toll attributed to coronavirus disease 2019 (COVID-19), but questions have persisted regarding deaths formally attributed to COVID-19. We aimed to provide an independent review of clinical features of patients who died during hospitalisation with a positive PCR test for SARS-CoV-2 and relate these to the reported cause of death. Between 23 March and 28 April 2020, a total of 162 patients with a positive SARS-CoV-2 PCR died in our NHS trust. COVID-19 infection was documented as the direct cause of death in 150 (93%). Review of the records revealed 138 (92%) patients had pulmonary infiltrates on chest radiography, and 146 (97%) required oxygen therapy. This retrospective review of cause of death has demonstrated that the overwhelming majority of hospitalised patients with positive SARS-CoV-2 PCR died as a direct consequence of COVID-19 infection.

KEYWORDS
  • COVID-19
  • SARS-CoV-2
  • coronavirus

Background and aims

The SARS-CoV-2 global pandemic is accompanied by an ever rising death toll attributed to coronavirus disease 2019 (COVID-19), and there is evidence of excess deaths in addition to those included in official daily COVID-19 mortality updates.1 Despite these daily updates of publicly available data in the UK, questions have persisted surrounding the circumstances of deaths formally attributed to COVID-19, with some media commentators suggesting many deaths may have been misattributed to COVID-19 infection, and that SARS-CoV-2 positivity in these patients is merely incidental.2–4

In the UK, the official COVID-19 daily mortality update provided by Public Health England includes all patients who died having tested positive for SARS-CoV-2 by polymerase chain reaction (PCR) from sputum or nasopharyngeal swab. However, it is not currently clear if these patients died as a direct consequence of COVID-19 infection.5

We aim to provide an independent review of the clinical features of patients who have died during hospitalisation with a positive PCR test for SARS-CoV-2 and relate these to the reported cause of death to clarify the proportion of patients who have died ‘due to’ compared to ‘with’ COVID-19 infection. This retrospective review of the electronic health records was approved through local process, and, as it was performed on the basis of monitoring of service provision, did not require local ethics approval.

Results

Between 23 March 2020 and 28 April 2020, a total of 162 patients with a positive SARS-CoV-2 PCR died in Leeds Teaching Hospitals NHS Trust. Of these, COVID-19 infection was documented as the direct cause of death in 150 (93%). Review of the records revealed 138 (92%) patients had pulmonary infiltrates on chest radiography, and 146 (97%) required oxygen therapy. Only two patients had neither of these findings, both of whom died from acute renal failure in the context of COVID-19 with serological evidence of systemic inflammation. Of the 12 (7%) patients who did not have COVID-19 reported as a direct cause of death, three deaths were due to dementia, three due to other infections, two due to comorbidities, one was due to malignancy and three were due to acute illness (renal failure, stroke and bowel ischaemia). The number of deaths each week throughout this period is presented in Fig 1.

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

Weekly deaths ‘due to’ compared to ‘with’ COVID-19 in in Leeds Teaching Hospitals NHS Trust.

Discussion

This retrospective review of cause of death demonstrates that the overwhelming majority of hospitalised patients with positive SARS-CoV-2 PCR in our Trust died as a direct consequence of COVID-19 infection. Numerous observational studies have reported outcomes and risk factors for mortality in COVID-19; however, the accuracy of causes of death have seldom been reported. One study described autopsy findings from 26 patients with reported cause of death as COVID-19, and found confirmatory evidence in 92%,6 consistent with our data.

These findings should provide reassurance to both medical professionals and the general public that cause of death reporting in hospitalised patients following positive SARS-CoV-2 tests provides an accurate representation of COVID-19 mortality in hospitalised patients.

  • © Royal College of Physicians 2020. All rights reserved.

References

  1. ↵
    1. Office for National Statistics
    . Deaths registered weekly in England and Wales, provisional. www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/weeklyprovisionalfiguresondeathsregisteredinenglandandwales [Accessed 13 May 2020].
  2. ↵
    1. Richardson R
    . Fact check: Is US coronavirus death toll inflated? Experts agree it's likely the opposite. USA Today, 17 April 2020. https://eu.usatoday.com/story/news/factcheck/2020/04/17/fact-check-covid-19-death-toll-likely-undercounted-not-overcounted/2973481001/ [Accessed 14 May 2020].
  3. ↵
    1. Lee J
    . The way ‘Covid deaths’ are being counted is a national scandal. The Spectator, 30 May 2020. www.spectator.co.uk/article/the-way-covid-deaths-are-being-counted-is-a-national-scandal [Accessed 31 May 2020].
  4. ↵
    1. Cahlmers V
    , Matthews S. Is Britain's Covid-19 death toll HALF of the 50,000 already recorded? Expert claims official tally may be too high because doctors are too keen to name the virus on death certificates and most victims were going to die anyway because they were elderly. The Daily Mail, 11 June 2020. www.dailymail.co.uk/news/article-8409677/Coronavirus-deaths-HALF-official-toll.html [Accessed 9 July 2020].
  5. ↵
    1. Public Health England
    . PHE data series on deaths in people with COVID-19: technical summary. PHE, 2020. Available from https://www.gov.uk/government/publications/phe-data-series-on-deaths-in-people-with-covid-19-technical-summary.
  6. ↵
    1. Elezkurtaj S
    , Greuel S, Ihlow J, et al. Causes of death and comorbidities in patients with COVID-19. medRxiv 2020; 2020.06.15.20131540.
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Dying ‘due to’ or ‘with’ COVID-19: a cause of death analysis in hospitalised patients
Thomas A Slater, Sam Straw, Michael Drozd, Stephe Kamalathasan, Alice Cowley, Klaus K Witte
Clinical Medicine Sep 2020, 20 (5) e189-e190; DOI: 10.7861/clinmed.2020-0440

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Dying ‘due to’ or ‘with’ COVID-19: a cause of death analysis in hospitalised patients
Thomas A Slater, Sam Straw, Michael Drozd, Stephe Kamalathasan, Alice Cowley, Klaus K Witte
Clinical Medicine Sep 2020, 20 (5) e189-e190; DOI: 10.7861/clinmed.2020-0440
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • ABSTRACT
    • Background and aims
    • Results
    • Discussion
    • References
  • Figures & Data
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Hospital at Home: another piece of the armoury against COVID-19
  • Utilising an automated medication inventory management system for emergency crash carts during the COVID-19 pandemic
  • Maintaining training progression in remote-working junior doctors
Show more COVID-19 rapid report

Similar Articles

FAQs

  • Difficulty logging in.

There is currently no login required to access the journals. Please go to the home page and simply click on the edition that you wish to read. If you are still unable to access the content you require, please let us know through the 'Contact us' page.

  • Can't find the CME questionnaire.

The read-only self-assessment questionnaire (SAQ) can be found after the CME section in each edition of Clinical Medicine. RCP members and fellows (using their login details for the main RCP website) are able to access the full SAQ with answers and are awarded 2 CPD points upon successful (8/10) completion from:  https://cme.rcplondon.ac.uk

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians