How Death is Attributed to COVID-19
COVID-19 is primarily a respiratory infection that attacks the lungs, making it harder for patients to breathe and get enough oxygen to the rest of the body.
World Health Organization guidelines states in part that a COVID-19 patient who dies should be documented as a Covid death.
"A death due to COVID-19 may not be attributed to another disease and should be counted independently of pre-existing conditions that are suspected if triggering a severe course of COVID-19," the WHO guidelines note.
Assigning the cause of death however is not straightforward.
A patchwork of rules and regulations, coupled with the rising number of household deaths, make getting accurate data on the exact number of Coronavirus-related deaths challenging.
Kenya has recorded 51 deaths and the Health Ministry has said all patients who succumbed to the contagion had some type of underlying health condition that might have worsened their situation.
So, how do we rule out the thought that one of these comorbidities could be the cause of death and not Covid-19?
Autopsy is the gold standard for determining the cause of death, a preserve of pathologists.
Without use of autopsy, the cause of death can be misclassified, according to Dr. Edwin Walong, a pathologist based at Kenyatta National Hospital.
In Covid-19, the immediate cause is usually respiratory distress syndrome.
A death certificate is signed by a physician who was responsible for a patient who died in hospital.
On the certificate, there are spaces to list the immediate cause of death, as well as the chain of events that led to that final disease or incident.
In the event of death, the immediate cause of death might be listed as respiratory distress, with the second line reading "due to Covid-19."
Contributing factors such as heart disease, diabetes or high blood pressure would then be listed further down.
But as Dr Walong states, different pathologists can have different opinions.
"We usually categories the cause of death into two: the immediate cause of death and contributory cause of death.
If someone who has tested positive for Covid-19 is knocked down by a vehicle, whereas I would assign that as a Covid-19 some of my colleagues will look at it as another road accident."
The difference of opinion is largely driven by the fact that so far very little is known about SARS-CoV-2 virus which triggers Covid-19.
He further opined, it is safer to assign all Covid-19 positive cases who succumb, to Covid-19 deaths.