Why aren’t all deaths involving positive cases count as COVID-19 deaths?

As Malaysia currently faces an increase in the number of new daily COVID-19 cases, the mortality rate is still relatively low at 0.4%. There are currently a total of 563 COVID-19 deaths out of the 144,518 positive cases recorded as of 13th January 2021.

Some on social media had implied that the Ministry of Health’s reporting on the COVID-19 related deaths are not up to date. Based on a screenshot of a post shared on Facebook, an individual said a father with COVID-19 had recently passed away. After the burial, the name didn’t show up on the list of new COVID fatalities. The individual questioned if authorities are disclaiming the COVID-19 deaths and asked if the actual deaths are actually higher.

Anesthesiologist and Intensive Care Specialist, Dr Nurilyani Bujang, has responded by explaining how COVID-19 deaths are classified. In her Facebook post, she explained every case must go through a discussion process by specialists to determine the cause of death. After several rounds and if a unanimous decision is reached, only then the data is submitted to the central authority. She added that this process could take time.

Death by Accident

She provided three examples of COVID-19 cases that are not classified death by COVID-19. If a person died due to an accident but was later tested positive, it won’t be classified as a COVID-19 death. This case is considered COVID stage 1 as the deceased didn’t show any symptoms. The remains will still be treated like a COVID-19 case as the individual is still infectious. Meanwhile, the family members of the deceased must undergo swab tests and quarantine.

Death by other infections

In the next example, a COVID-19 patient was admitted to a hospital and was classified as COVID-19 stage 5. After 3 months in the hospital, he had recovered from COVID-19 and was tested negative. Unfortunately, the patient passed away due to other congenital infections. In this scenario, he won’t be classified as a COVID-19 death despite earlier admission as a COVID-19 patient.

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Death by Heart Attack

In the last example, a person was admitted to the hospital due to a heart attack and had passed away. During screening, the individual was tested positive for COVID. Similar to the first example, the cause of death isn’t COVID and is caused by a heart attack. However, the management of the remains and close contacts will still be the same as a COVID-19 patient.

What’s considered as COVID-19 death?

Source: Ministry of Health

Dr Nurilyani explained that COVID-19 deaths are only considered if it is caused by COVID-19 stage 4 and 5. Based on the definition by the Ministry of Health, Stage 4 are cases that are symptomatic with pneumonia which require supplemental oxygen supply such as a ventilator. Meanwhile Stage 5 is the most critical with multi-organ involvement.

On 8th January 2021, Malaysia had reported a record high of 16 COVID-19 deaths in a single day. However, these figures are not necessary deaths recorded in the past 24 hours. As explained by the Health D-G Dr Noor Hisham Abdullah, the increase in the number of deaths was due to more time needed to investigate the cases before it can be officially declared as COVID-19 deaths.

At the moment, non-severe COVID-19 positive cases will undergo treatment and quarantine at home while being monitored by health workers. These patients would be quarantined at home for 10 days and a screening will be conducted at their respective homes on the last day to determine if they are free from COVID-19. Only those with symptoms will be treated in hospitals.

However, the move to allow home quarantine for non-severe COVID-19 cases also depends on the sufficient space of isolation at home. If the house is too small or crowed, the patients would be taken to the hospital.

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Alexander Wong