Understanding COVID-19 causes of death

Knowing the actual cause of death is important to interpret COVID-19 fatality rates, although it is often hard to evaluate.

Some patients die before reaching hospital because they either present too late or end-of-life care is preferred. Also, not all severe cases reach the intensive care unit (ICU). Low chances of survival cases may be treated only in middle care units. Cases in the ICU that need the resource-intensive extracorporeal membrane oxygenation (ECMO) or dialysis may not get them due to lack of support.

It is important to consider the following:

Deaths in ICU patients despite full intensive care.
Deaths due to limitation of life-support related to low chances of survival, to scarce resources, or both.
Deaths not directly related to COVID-19 e.g. trauma patients admitted to ICU for other reasons may test positive for COVID-19 but die due to the original trauma, or patients positive for COVID-19 who die from underlying conditions.

The authors say data needed to interpret fatality rates includes the type and severity of organ failure, the actual process of death (therapeutic limitations, patient or environmental factors), and the real contribution of COVID-19 to individual deaths.

The article is published in Lancet Respiratory Medicine