In the current situation, death toll reports are some of the most distressing pieces of information that one can come across. It would appear that the number of deaths due to Covid-19 in Italy is very large with respect to the rest of the world. Given that we are not experts in mortality nor in Italian death registration procedures, we asked our friend and colleague (now retired but still very active!) Viviana Egidi, full professor of health statistics at “La Sapienza” University of Rome.
Let us, therefore, have a closer – and global – look at how deaths are usually registered.
In general, after the death of a patient, a medical certificate of cause of death (MCCD) has to be filled in. Indeed it is form agreed in its content and organization with the World Health Organization. This certificate has various sections. The first part refers to the late patient’s health situation and is filled in by the doctor who is certifying the patient’s death. The first section of this part of the certificate refers to the process that leads to the patient’s death. The leading cause of death – i.e. the cause that started the patient’s death process – is listed first, followed by a list of any of its possible consequences (other diseases or physical deficiencies) which were part of the death process. Each term in the said list has an associated code determined by the World Health Organization (WHO) agreements. Covid-19 is a new cause of death; like other viruses, SARS-CoV-2 causes double pneumonia. However, being a new virus, it required a new specific its WHO codification; a new exclusive code had to be assigned to it. The identification of the leading cause of death depends on how the doctor interprets the clinical picture. For example, in the presence of a tumor and infectious disease such as pneumonia, the doctor might register the leading cause of death as “tumor”, especially if in a terminal stage. If the tumor is instead at an early stage, the doctor might list pneumonia as the leading cause of death and cite the presence of the tumor as secondary. The certificate is then transmitted, checked, and encoded in a long and complex process which we will cover in a future article.
The current situation is very different. Ordinary channels of information management have been altered in order to gain information quickly. A group of experts has been assembled at the Istituto Superiore di Sanità (ISS) [translator’s note: Italian National Institute of Health] to receive information for each death where the patient had resulted positive to Covid-19. They are firstly notified by the laboratory responsible for certifying swab tests (Spallanzani hospital in Rome). Furthermore, they receive the usual MCCDs (the above-mentioned case of death certificates), and, among these, they also analyze randomly sampled clinical pictures. Laboratory notifications and the death certificates are especially important in determining whether the leading cause of death was Covid-19, which, if present, is generally presumed as such. Germany has instead decided to classify as “Covid-19 deaths” only those cases where the latter was the leading death cause.
It must also be noted that the life expectancy of Italians is currently very high, and the quality of life is very good. This is due to the fact that it is possible - and likely - to go through old age in the presence of some diseases. 67% of people aged 75+ live with 3 or more serious chronic diseases. Women at age 75 can easily expect to live 10 more years, while men can expect to live at least 5 more years. It is therefore important to stay home to protect everyone and to allow everyone to live happily and long.
(Translation: Gabriele Fabozzi)
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