Acute respiratory infections including COVID-19, Influenza and Respiratory Syncytial virus
Terminology
Viral illnesses should be recorded on the Medical Certificate of Cause of Death (MCCD) where the disease caused, or is clinically diagnosed as having caused, or contributed to death. Viral illnesses should be recorded in Part 1 where it was a part of the chain of events leading to death. Viral illnesses should be recorded in Part 2 where they are thought to have contributed to the death but was not part of the direct chain of events leading to death.
COVID-19:
- Do not use the term coronavirus. Instead state that is was COVID-19, SARS-CoV-2, etc.
- Specify whether the infection is current or a sequelae complication (e.g. long COVID-19).
Influenza:
- State the strain if known (e.g. Influenza A, B or H1N1).
The following example demonstrates how a death due to a viral illness may be certified. The strain is clearly specified, as are complications of the virus.
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Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Respiratory failure. Approximate interval between onset and death: 1 day
- Part 1(b): Viral pneumonia. Approximate interval between onset and death: 5 days
- Part 1(c): Influenza A. Approximate interval between onset and death: 10 days
- Parts 1(d) and 1(e): Blank. Approximate interval between onset and death: Blank
- Part 2: Prostate adenocarcinoma, past myocardial infarction, atrial fibrillation. Approximate interval between onset and death: 5 years, 3 years, 3 years
Complications of viral illnesses leading to death
Specification of the causal pathway leading to death in Part 1 of the certificate is important and all conditions and symptoms should be included. For example, in cases where COVID-19 causes pneumonia and fatal respiratory distress, both pneumonia and respiratory distress should be included along with COVID-19 in Part 1. The duration of each disease and symptom should also be included. Certifiers should include as much detail as possible based on their knowledge of the case, medical records, laboratory testing, etc.
The following two examples show how complications of a viral illness can be certified.
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Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Acute respiratory distress syndrome. Approximate interval between onset and death: 2 days
- Part 1(b): Respiratory syncytial virus pneumonitis . Approximate interval between onset and death: 2 weeks
- Parts 1(c) 1(d), 1(e) and Part 2: Blank. Approximate interval between onset and death: Blank
Image
Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Acute respiratory distress syndrome. Approximate interval between onset and death: 2 days
- Part 1(b): COVID-19 pneumonia. Approximate interval between onset and death: 10 days
- Part 1(c): COVID-19. Approximate interval between onset and death: 12 days
- Parts 1(d), 1(e) and Part 2: Blank. Approximate interval between onset and death: Blank
Viral illnesses with co-morbidities
Existing conditions, especially those which are chronic in nature, may have also contributed to death and should be certified in Part 2 of the MCCD. Chronic conditions may include but are not limited to coronary artery disease, chronic obstructive pulmonary disease, diabetes, cancer or disabilities.
The following three examples show how comorbidities may be certified on the MCCD for deaths due to acute respiratory illnesses.
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Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Acute respiratory distress syndrome. Approximate interval between onset and death: 2 days
- Part 1(b): COVID-19 pneumonia. Approximate interval between onset and death: 10 days
- Part 1(c): COVID-19. Approximate interval between onset and death: 12 days
- Parts 1(d) and 1(e): Blank. Approximate interval between onset and death: Blank
- Part 2: Coronary artery disease, type 2 diabetes, chronic obstructive pulmonary disease, hypertension. Approximate interval between onset and death: 10 years, 20 years, 10 years, 10 years
Image
Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Acute respiratory distress syndrome. Approximate interval between onset and death: 2 days
- Part 1(b): Acute pulmonary fibrosis. Approximate interval between onset and death: 10 days
- Part 1(c): COVID-19. Approximate interval between onset and death: 12 days
- Parts 1(d) and 1(e): Blank. Approximate interval between onset and death: Blank
- Part 2: Diffuse large B cell lymphoma, immunosuppressant therapy. Approximate interval between onset and death: 5 years, 5 years
Image
Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Acute respiratory distress syndrome. Approximate interval between onset and death: 2 days
- Part 1(b): Pneumonia. Approximate interval between onset and death: 10 days
- Part 1(c): Respiratory syncytial virus. Approximate interval between onset and death: 12 days
- Parts 1(d) and 1(e): Blank. Approximate interval between onset and death: Blank
- Part 2: Cerebral palsy. Approximate interval between onset and death: 80 years
Long COVID-19
If a past COVID-19 infection caused lasting complications which lead to death, the original infection should be certified on the MCCD. This is demonstrated in the following example.
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Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Respiratory failure. Approximate interval between onset and death: 2 days
- Part 1(b): Lung fibrosis. Approximate interval between onset and death: 2 weeks
- Part 1(c): Long COVID-19. Approximate interval between onset and death: 6 months
- Parts 1(d), 1(e) and part 2: Blank. Approximate interval between onset and death: Blank
Acute respiratory infections as contributing causes of death
Acute respiratory infections should be recorded as a contributing cause of death where an individual is positive for a viral illness but there is a disease or injury pathway to death that is not directly caused by the virus. For example, a person may have late stage cancer that has metastasised extensively causing organ damage leading to death. This person may also have contracted COVID-19. While the virus or its complications may have negatively impacted health in an immuno-compromised person, the virus itself did not cause the terminal event leading to death (e.g. organ failure caused by metastases). In this circumstance, the viral illness should be certified in Part 2.
Incidental viral infections which did not contribute to the death should not be certified on the MCCD.
The following two examples show how an acute respiratory illness can be certified in Part 2 of the MCCD.
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Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Multiple organ failure. Approximate interval between onset and death: 2 days
- Part 1(b): Bone and liver metastases. Approximate interval between onset and death: 2 months
- Part 1(c): Invasive ductal carcinoma of right breast. Approximate interval between onset and death: 4 years
- Parts 1(d) and 1(e): Blank. Approximate interval between onset and death: Blank
- Part 2: COVID-19, chemotherapy-induced thrombocytopenia, type 2 diabetes, coronary artery disease. Approximate interval between onset and death: 4 days, 2 months, 20 years, 10 years
Image
Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Traumatic subdural haemorrhage. Approximate interval between onset and death: 2 hours
- Part 1(b): Fall from bed with headstrike. Approximate interval between onset and death: 2 hours
- Parts 1(c), 1(d) and 1(e): Blank. Approximate interval between onset and death: Blank
- Part 2: COVID-19, frailty, bedbound, Alzheimer’s disease. Approximate interval between onset and death: 7 days, 4 weeks, 4 weeks, 15 years