‘Died from’ or ‘died with’ COVID-19? We need a transparent approach to counting coronavirus deaths

Marc Trabsky, La Trobe University and Courtney Hempton, Deakin University

The COVID-19 death toll is reported every day by state and federal governments. These numbers are often used, alongside case numbers, to assess how public health policies are faring in controlling the pandemic, and to gauge the success of various drugs or interventions.

There’s been confusion, however, over whether reported death statistics reflect those who’ve died from COVID-19, or those who’ve died with the virus. Often it’s hard for medical practitioners to determine which of these categories a death falls into.

But the COVID-19 death toll publicised daily on Australian state and territory government websites and reported to the press does not differentiate between the two. It includes all people who’ve died with SARS-CoV-2 (the virus that causes COVID-19) in their body. It’s unclear if the federal government currently makes this distinction or not.

Lumping these statistics together makes it hard for the public to understand the true impact of the virus. Clarifying what’s being counted as a COVID-19 death is necessary for understanding the impact of the virus, and for informing public health and clinical responses to the pandemic. If we know who is susceptible to dying with COVID-19 because of pre-existing conditions, public health responses could more effectively target and protect potentially vulnerable people and communities.

We are not suggesting this is a reason to downplay the seriousness of the virus, but rather that successful public health engagement requires open communication of death causation data, especially in a pandemic. Therefore, we need a transparent approach to counting and reporting coronavirus deaths in Australia.

Cause of death is not straightforward

Federal Deputy Chief Medical Officer Nick Coatsworth acknowledged that determining cause of death is complex when questioned by reporters on Tuesday, saying:

I remember as a junior doctor trying to do death certificates – it’s not always an easy thing […] I don’t, by any stretch of the imagination, think it’s a reason to underplay the severe impact that COVID has on people who have [pre-existing] conditions.

Indeed, distinguishing between dying with and dying from COVID-19 may require a more complex investigation into the cause of a death, beyond citing a positive SARS-CoV-2 test that was completed prior to the person’s death.

For example, Victoria’s coroner is currently investigating the death of a man in his twenties, who was widely reported as being Australia’s youngest coronavirus death. The coroner is investigating whether his death was primarily caused by SARS-CoV-2, or whether the virus contributed less substantially to his death.

While this death was reported on August 14 in Victoria’s daily death toll, according to The Sydney Morning Herald, as of August 28 it wasn’t counted in the federal COVID-19 death tally. It remains unclear whether the death has been added to the federal count as of today.

Generally when a person dies a medical practitioner is responsible for indicating the cause of death. The doctor will complete a “medical certificate of cause of death”, and inform the Registry of Births, Death and Marriages in their state or territory.

In some circumstances, the cause of a death can also be reported by a coroner, but they typically investigate deaths that are sudden, unnatural, violent or accidental, or which occur during or after medical procedures. The cause of death may be initially unclear at the beginning of a coronial investigation. Sometimes, the determined cause of death may be multiple, while other times it may change when more information is revealed, for example through a post-mortem examination or toxicology tests, or when new information comes to light about how a virus affects the body.

We don’t know the true death rate

The lack of nuance in Australia’s COVID-19 death tally means the true death rate may be unknown, and may be adjusted in the future.

For example, on August 31 Victoria recorded only eight COVID-19 deaths from the previous 24 hours, but also added 33 historical deaths to the toll. According to the state’s Chief Health Officer Brett Sutton, this backlog was due to changes in how aged care providers reported COVID-19 deaths, and differences in reporting methods between the state and federal governments.

On September 4 there were six deaths recorded over the previous 24-hours, but a further 53 historical deaths were added to the daily toll, 50 of which were related to aged care.

There is a lack of transparency about why there is a discrepancy between how Victoria and the Commonwealth count COVID-19 deaths.

A spokesperson for federal Aged Care Minister Richard Colbeck suggested delays in data collection and reporting are the primary reasons for the discrepancies. But there appeared to be confusion in early August in the aged care sector about the necessity of reporting “all COVID-19 related deaths, including those involving other causes or comorbidity factors”, according to a letter written to Victorian aged care providers from the secretary for the Department of Health, Brendan Murphy.

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Read more:
Have there been uncounted coronavirus deaths in Australia? We can’t say for sure, but the latest ABS data holds clues

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Delays may have been caused by aged care providers struggling to verify not only residents who died from COVID-19, but also those suspected to have died with the virus.

The Victorian and Commonwealth governments are reportedly working to reconcile how COVID-19 deaths are counted and reported. But it may be months or years before detailed death data can be analysed.

In the meantime, we need more detail about what’s being reported in the daily COVID-19 death data, and governments should be transparent about what is (and is not) being counted as a COVID-19 death.

Marc Trabsky, Senior Lecturer, La Trobe Law School and Director, Centre for Health, Law and Society, La Trobe University and Courtney Hempton, Associate Research Fellow, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Counting the Numbers: A Hopeful Sign of Some Change

The article below is about one megachurch pastor in the United States and his questioning of marketing values in the church today. I think there are some hopeful signs in his comments, but there is no convincing evidence of a better way about to be trod.

For more see:
http://www.christianpost.com/news/churches-more-like-fast-food-restaurants-one-pastor-thinks-so-50738/

 

Uzbekistan: arrests in one of the biggest churches

On May 16, 2010 law-enforcement agents of the Republic of Uzbekistan carried out a raid on one of the biggest churches in the country – Tashkent City Church of Christ, reports Christian Telegraph.

During the morning service at 11.00 AM several police officers and agents of the national security service came to the church. Part of them began filming the service, including people’s faces and church offices.

After the end of the service, police officers stopped people, took their passport information and wrote down the names of all children and car identification numbers. During the morning service there were about 500 people, not counting kids.

During several hours police officers and agents of the national security service searched through the church building. They confiscated six computers, a scanner and books, written permissions from parents, who allowed their kids to come to church, and other documents. Police officers also opened up donation boxes.

At about 01.00 PM the raid organizers called representatives of different city services to the church building – sanitary and epidemiological service, fire inspection and tax inspection that in obligatory procedure “found” violations.

Searching and all forms of examinations continued through the whole day. As the result, the second service that had to begin at 04.00 PM was cancelled. The church office was closed and sealed; the panelboard was cut of current.

Soon eight people, ministers and members of the church among them, were taken to Mirso-Ulugbeksk local office of the internal affairs of the city of Tashkent. The assistant pastor Arthur Avanesian was also arrested. Two church members were arrested for filming of what was happening on their mobile phones.

Christians were in custody through the night and were denied to meet with their relatives. On Monday their cases will be submitted to the court for the decision on the merits. As relatives say, they might be under strong pressure to give convenient confessionary statements.

Tashkent City Church of Christ is considered religious organization, which was officially registered in August of 1999. During the time of its existence, the church has never had any admonitions, it led its activity according to the law and had different examinations by state services. The last examination was held by the Department of Justice of the city of Tashkent just two months ago.

All actions by the authority give all reasons to believe that the raid was carried out in order to find reasons to close the church.

Report from the Christian Telegraph 

Christians in Jos, Nigeria Fear Further Attacks

Churches burned following assault on Catholic church in volatile Plateau state.

LAGOS, Nigeria, January 19 (CDN) — Gunshots and smoke continued to alarm residents of Jos in central Nigeria today, with the Christian community fearing further violence from Muslim youths who on Sunday (Jan. 17) attacked a Catholic church and burned down several other church buildings.

A 24-hour curfew imposed yesterday in Jos and the suburb of Bukuru by the Plateau state government was extended through Wednesday. Police said continuing violence was initially triggered by Sunday’s unprovoked attack by Muslim youths on worshippers at the St. Michael’s Catholic Church in Nasarawa Gwong, in the Jos North Local Government Area.

Also burned were buildings of the Christ Apostolic Church, Assemblies of God Church, three branches of the Church of Christ in Nigeria and two buildings of the Evangelical Church of West Africa, Christian leaders said.

The number of casualties continued to grow, reportedly reaching more than 100 as security forces tried to rein in rioters, with both Christian and Muslim groups still counting their losses. Hundreds have reportedly been wounded.

“We have been witnessing sporadic shootings in the last two days,” said the Rev. Chuwang Avou, secretary of the state chapter of the Christian Association of Nigeria. “We see some residents shooting sporadically into the air. We have also seen individuals with machine guns on parade in the state.”

Avou said many of those who are shooting are civilians, not policemen, and that they have been mounting road blocks and causing chaos in the area. At least 35 people have been arrested.

“What we have witnessed only goes to show that the problem in the state is far from over,” he said. “Many families have been displaced. There are a number who are receiving treatment in the hospital. The dusk-to-dawn curfew imposed in the state has not solved any problem, as there is still tension in the land.”

Avou said the crisis broke out when Muslim youths pursued a woman into a church during worship on Sunday, wreaking havoc on the service.

“Some Muslim youths invaded some churches and started burning and destroying properties,” he said. “We were told that the youths pursued a lady to the church. Nobody knew what the lady did. What we just discovered was that the entire atmosphere was ignited and houses were being burned.”

A Muslim group in the area, however, dismissed claims that Muslim youths ignited the tensions. They accused Christian youths of stopping a Muslim from rebuilding his house.

State Commissioner of Police Greg Anyating stated that Muslim youths were to blame for setting off the violence.

As violence continued today, there was a mass movement of Christians and Muslims from areas where rampaging youths were unleashing mayhem on the city despite heavy security. The Nigerian army was reportedly summoned to try to restore order.

The Rev. Ignatius Kaigama, co-chairman of the state Inter-Religious Council and Catholic Archbishop of Jos, condemned the recurring civil disturbances in the state and called on all to “sheath their swords and be their brothers’ keepers.”

The secretary of the Pentecostal Fellowship of Nigeria, Pastor Wale Adefarasin, said attacks on Christians are a manifestation of terrorism in the country.

“What we should realize is that the government is not helping situations,” he said. “It is an illusion that Nigeria is safe.”

He added that terrorism affects both Christians and Muslims negatively, and that it is the duty of elected officials to ensure that terrorists are detected early and deterred.

“The Muslim fundamentalists want to take over Jos by all means,” Pastor Adefarasin said. “They claim that Jos is a Muslim state, which is not true.”

Violence hit the same area on Nov. 28-29, 2008, when murderous rioting sparked by Muslim attacks on Christians and their property left six pastors dead, at least 500 other people killed and 40 churches destroyed, according to church leaders. More than 25,000 persons were displaced in the two days of violence.

What began as outrage over suspected vote fraud in local elections quickly hit the religious fault line as angry Muslims took aim at Christian sites rather than at political targets. Police and troops reportedly killed about 400 rampaging Muslims in an effort to quell the unrest, and Islamists shot, slashed or stabbed to death more than 100 Christians.

The violence comes at a time of a leadership vacuum in Nigeria, with illness requiring Muslim President Umaru Yar’Adua to leave the country on Nov. 23 to seek treatment in Saudi Arabia.

Sectarian violence in Jos, a volatile mid-point where the predominantly Muslim north meets the mainly Christian south, left more than 1,000 people dead in 2001. Another 700 people were killed in sectarian outbreaks of violence in 2004. Located in Nigeria’s central region between the Muslim-majority north and the largely Christian south, Plateau state is home to various Christian ethnic groups co-existing uneasily with Muslim Hausa settlers. 

Report from Compass Direct News 

NIGERIA: DEATH TOLL CLIMBS IN ATTACK BY ISLAMIC SECT

12 Christians killed, 20 churches burned in Borno rioting prompted by extremist group.

LAGOS, Nigeria, Aug. 7 (Compass Direct News) – With 12 Christians, including three pastors, confirmed killed in rioting ignited by an Islamic sect opposed to Western education, the Christian community in northern Nigeria’s Borno state is still counting its losses.

The rioting instigated by an Islamic extremist sect known as Boko Haram, which initially attacked police and government bases, left hundreds of people dead and large property losses. Sharia (Islamic law) is already in force for Muslims in 12 northern states, but the sect is fighting to have it enforced more broadly in those states and to impose it throughout Nigeria.

“We are still taking inventory of how the crisis affected our members, but so far we have confirmed some of the Christians killed and churches burnt,” Samuel Salifu, national secretary of the Christian Association of Nigeria (CAN), told Compass.

Rampaging members of the sect burned 20 churches before police captured and killed Boko Haram’s leader, Mohammed Yusuf. Police say Yusuf was killed “while trying to escape,” but a federal government panel is investigating allegations that security agents executed him after arresting him alive in his hideout.

The chairman of the Borno state chapter of CAN, the Rev. Yuguda Zubabai Ndurvuwa, said many Christians abducted by Boko Haram extremists were yet to be found. He noted that the Christian community usually has been hardest hit in religious uprisings in Borno and other northern states. Violence started on July 26, when armed sect members attacked a police station in Bauchi state that set off a firestorm of violence that spread to the northern states of Borno, Kano and Yobe.

Those killed in Borno include Pastor Sabo Yakubu of Church of Christ in Nigeria (COCIN), the Rev. Sylvester Akpan of National Evangelical Mission and the Rev. George Orji of Good News of Christ Church International, Inc.

Church buildings burned in Borno include five branches of the COCIN denomination, two Catholic churches, two Deeper Life Church buildings, two EYN (Church of the Brethren in Nigeria) buildings, and buildings of the National Evangelical Mission, Celestial Church of Christ, Elijah Apostolic Church, The Lord’s Chosen Charismatic Revival Ministries, Assemblies of God Church, Redeemed Christian Church of God, Christ for All Nations, Baptist Church and Anglican Church, all in different parts of the state.

Nigeria has almost equal numbers of Christians and Muslims, with the north dominated by Muslims and the south largely Christian. Northern Nigeria has a history of religious crisis with heavy casualties among Christians.

A Maiduguri, Borno-based journalist, Abiodun Joseph, said members of the sect kidnapped his two sons after he and his family narrowly escaped being lynched by the sect members.

“They stopped us while leaving the estate where I live, which is close to their headquarters, and threatened to shoot myself and my wife if we resisted the abduction of my two sons,” Joseph told Compass. He found his sons two days later.

“It was a very harrowing experience as we were not sure what would happen to them, but we thank God that they were not killed like others,” Joseph added.

Many other abducted Christians, he said, were killed by rioters for refusing to renounce their faith.

Facing Loss

With calm restored, Pastor Enouch Atiyaye, chaplain of the University of Maiduguri Teaching Hospital, said Christians in Borno who were forced to abandon their homes have been returning to “face the loss of their family members and the burning of their churches and homes.”

“There is a general feeling of despair and dejection among Christians with a high degree of uncertainty, since we don’t know what can happen next,” Atiyaye told Compass. “The fear is that the Boko Haram group has many members who have entrenched themselves in the state over the years. They disappeared during the crisis and can regroup to fight back if necessary security measures are not in place.”

Based on the attack on Christians during the Boko Haram uprising and past experiences, CAN’s Salifu said the association has lost confidence in the ability of the government to provide security for the lives and property of its members.

“If the government continues the way it has been doing, the association would have to give conditions for the co-existence of the various groups in the country” Salifu said at a press conference in Abuja, the country’s capital, on Monday (Aug. 3).

Accusing Borno Gov. Ali Modu Sheriff of complicity in the emergence of the Boko Haram group, Salifu said Christians were apprehensive that there are dangers beyond what was apparent in the sect’s uprising.

“We have no doubt in our minds that they would have perceived Christianity as a Western religion, which to them is also haraam [sin] which must also be eradicated,” he said.

At the press conference the Rev. Ladi Thompson, international coordinator of Macedonian Initiatives, a Christian Non-Governmental Organization, accused the government of ignoring warnings by Christian leaders on Boko Haram activities, which he said could have been nipped much earlier.

The governor’s press director, Usman Ciroma, dismissed CAN’s claim of complicity by Gov. Sheriff, saying that it was preposterous and laughable that the tragedy that befell the state could be trivialized in that way.

“Which politician will be so suicidal as to set a group to kill his own people?” Ciroma reportedly said.

The governor, who denied any relationship with the Islamic sect, met with Christian leaders in Borno state for the first time on Wednesday (Aug. 5), during which he disclosed plans to regulate preaching by religious leaders. For two years, according to news reports, attempts by Christian leaders to meet the governor over the plight of Christians in the state had been rebuffed.

“Government officials at the meeting tried to claim that Muslims were not more affected by the crisis, but the there is no indication that any mosque was burnt or any imam killed,” said a Christian leader at the meeting who requested anonymity.

Report from Compass Direct News 

5000 VISITORS

This Blog had its 5 000^th visitor today – a small milestone, but one that has amazed me. This is especially so given that there has been over 1240 visitors in the past week and 2232 visitors and counting so far this month. So there has been a dramatic increase in visitors to my Blog this month. On the 17^th September this Blog had its highest number of visitors ever, with 387 on that one day.

So why mention this anyway – simply to say thanks for coming along and having a read. I appreciate it and hope the visit has been worthwhile.

Kevin for Particular Kev’s Random Thoughts