‘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.

AZERBAIJANI PASTOR VOWS TO FIGHT ON; MINISTRY CONTINUES TO PRAY

Slavic Gospel Association has been following the trial of a persecuted Azerbaijani pastor who was arrested and held on false charges. SGA’s Joel Griffith says they just got the verdict, reports MNN. “Pastor Hamid Shabanov was actually convicted on the false charge of possessing an illegal weapon.”

Unless Shabanov’s conviction is quashed, he will have a criminal record. Griffith says, “He’s insisting that he’s innocent. He’s going to continue fighting to clear his name.”

The court gave Shabanov a two-year corrective labour sentence. However, because imprisonment counts as three times’ corrective labour, Shabanov’s sentence is the equivalent of eight months’ imprisonment. As he was in pre-trial detention or house arrest for just over seven months, he has 27 days more to serve from February 11.

Griffith says there’s a question as to whether Shabanov will have to go back to jail at all. He was also fined 20 percent of his salary for the remaining 27 days of his sentence. But Shabanov does not have a job, therefore he does not have a salary.

It’s interesting to note that the conviction might have been an acknowledgment of Shabanov’s innocence. “If he had actually been found innocent, then that reflects poorly on the police and the authorities, and it could get them into some sort of legal ‘hot water.’ So it’s assumed that convicting him but not sending him to jail was sort of a way for the local authorities to ‘save face.'”

Pastor Shabanov told Forum 18 that at the trial, he repeatedly said that he was being prosecuted to punish him for his Christian faith. His ministry has gotten particularly close scrutiny. Although SGA supports work in the region, there is much opposition.

Report from the Christian Telegraph

TURKEY: MALATYA MURDER CASE AIDS PROBE OF ‘DEEP STATE’ CRIMINALS

Video testimony, reenactment of crime scene hints at hearts of killers, martyrs.

ISTANBUL, November 25 (Compass Direct News) – Last week’s court hearing on the bloody murder of three Christians in Turkey’s southeastern city of Malatya paved the way for further investigations into the connection between the five defendants and shadowy elements of the Turkish state linked to criminal activities.

The 13th hearing at Malatya’s Third Criminal Court on Friday (Nov. 21) in the murders of Turkish Christians Necati Aydin and Ugur Yuksel and German Christian Tilmann Geske presented little new evidence. No witnesses were called to testify.

The court prosecutor and plaintiff lawyers, however, are pursuing proof that there are links between the murderers and Ergenekon, an ultranationalist cabal of retired generals, politicians, journalists and mafia members under investigation for conspiracy in recent murders.

A separate criminal investigation has linked the cabal to high-profile attacks, murders and plans to engineer domestic chaos and ultimately overthrow the government. Evidence in the Malatya case indicates that a local journalist, Varol Bulent Aral, acted as a bridge between the five murder suspects and Ergenekon.

Plaintiff attorneys also believe that Aral incited the suspected ringleader of the attack, Emre Gunaydin, to murder by convincing him foreign missionaries were connected to the Kurdistan Worker’s Party, a domestic outlawed terrorist organization.

According to a Nov. 14 statement, Gunaydin testified that Aral promised him state immunity for the planned attacks. In court last week, however, he refuted the claim and said he hadn’t met with Aral.

On April 18, 2007 the three Christians were tied up, stabbed and tortured for several hours before their throats were slit in what Turkish media have dubbed “the Malatya massacre” at the Zirve Publishing Co. office in Malatya.

Gunaydin along with Salih Gurler, Cuma Ozdemir, Hamit Ceker and Abuzer Yildirim, who have been in jail for the past 19 months, are accused of the murder. They are all between 19 and 21 years old.

Per their request, plaintiff attorneys have received the Ergenekon file from the 13th High Criminal Court of Istanbul and have reviewed it for connections with the Malatya murders. It is now under investigation by the court prosecutors and judges.

“We are talking about a room with five guys and three men,” said Orhan Kemal Cengiz, who leads the team of plaintiff lawyers. “There is no doubt this is first degree murder; a barbaric act. These things will increase their term of punishment to three counts of murder and three life imprisonment terms each, as well as other crimes such as preventing freedom, stealing and others. We don’t have a question about this.”

The question that remains, according to the plaintiff attorneys, is the identity of the real powers behind the bloody attack. Cengiz said he and the court now have no doubt there were greater forces behind the Malatya murders.

“I am 100 percent sure – it is the impression of the prosecutor and no one has doubts – there are sources behind these young men, but we can’t identify them,” Cengiz told Compass.

The plaintiff team hopes to bring up to 21 witnesses to the stand in subsequent hearings in order to make connections between Ergenekon and the Malatya murders clear.

“We believe all of them are somehow connected and have relevant information to this case,” he said.

If the list is accepted, he said the trial may go on for another year. “But if nothing comes out last minute, it may be over in three or four months,” he said.

 

Missionary Activities on Trial, Again

At Friday’s hearing, defense lawyers reiterated their position that the five young men acted in response to missionary efforts, suggesting that such activities were sufficiently nefarious to incite the violent murders.

The prosecution team rebutted the statement, saying that according to constitutional Articles 9 and 24, people have the right to share their faith, and no person or authority can follow and record those activities. They pointed out that the five defendants had been collecting data and planning the murders at least eight months before they carried them out.

Defense lawyers also requested that the prison where the defendants are held conduct a psychological exam of the defendants – especially Gurler – because they were all under stress due to suspected ringleader Gunaydin’s threats.

 

Revisiting Crime Scene

Those present in the courtroom on Friday viewed year-old video footage of defendants Ozdemir, Ceker and Gunaydin each walking through the crime scene shortly after their arrest, describing how they attacked, stabbed and sliced the throats of Aydin, Geske and finally Yuksel.

A sobering silence prevailed in the courtroom as judges, lawyers, local press, Turkish Protestant observers and others watched Ozdemir and later Ceker walk through the Zirve publishing house and re-enact the murders over the dried blood pools of the three martyrs. In their accounts, they implicated Gunaydin and Salih as the main aggressors, although all accuse the others of participating in the murders.

During the video presentation, judges and lawyers noticed suspect Gurler laughing at the witnesses’ testimonies at the crime scene. In the video, Ozdemir and Ceker testified that they had told Gurler and Gunaydin they couldn’t take the violence.

In the video testimony, Ozdemir said he told Gurler while he was stabbing Aydin, the first to be killed, “That’s enough, I can’t do this.” Ozdemir looked down during his video testimony, forlorn and unable to watch.

Gurler later told angry judges that he was laughing because all the witnesses’ statements in the video were false.

“They’re lying against me,” he said.

In his video account of the murder scene, Ceker described how the five young men and the three Zirve staff members talked “a lot” about religion before the suspects attacked Aydin, tying him and lying him on the floor face down.

Gunaydin confronted Aydin about his missionary activities and asked him why he was acting “against Turks” before Gurler sliced his throat, according to Ceker’s original statement.

In Gunaydin’s video testimony, profusely sweating, he described the repeated stabbings of the victims, re-enacting his arm movements and describing how Ozdemir held a gun at the victims, threatening them.

“I didn’t look,” Gunaydin said after describing one of the violent stabbing scenes. “I’m weak about these things … I can’t even cut chicken.”

He described how while Yildirim and Gurler were repeatedly stabbing Geske, the victim lifted his hands up in a gesture of prayer. Gunaydin also described how Yuksel, injured by the stabbing while tied and on the floor, cried out in Turkish, “Mesih, Mesih [Messiah],” between moans before they stuffed a towel in his mouth to silence him.

After the court showed his video testimony, Gunaydin stood up and told the court he had just gotten out of the hospital at that time, and that that account was not how he now remembered the events of April 18, 2007.

In their video testimony, the young men described how the phone and doorbell were ringing while they were torturing the Christians. Before coming out the door with their hands in the air, they showed police interviewing them in the video how they had disposed of their guns and bloodied knives in the Zirve office.

Gunaydin escaped through a window, fell and was severely injured. On Friday plaintiff lawyers requested from the court an investigation into who entered the crime scene while Gunaydin was in the hospital.

When the defendants were asked whether they knew of Aral’s alleged offer of state protection to Gunaydin or a monetary award for the murders, they claimed to have no information.

“I never saw a check in the course of these events, nor did I hear anything about it,” said Gurler. “I only knew that Emre had a bank statement.”

Yildirim also claimed ignorance: “I don’t remember anything about a check. If Emre had one, it would have stayed in his pocket; he wouldn’t have showed it to us.”

When asked about meetings between Gunaydin and Aral, the defendants said they hadn’t witnessed any between the two. They did admit to having spoken to Aral at a sports complex about a different matter, but they knew him as “Mehmet.”

 

Foreign Press, Organizations Negligent

Twelve of the nearly 20 private and human rights lawyers from around Turkey that compose the plaintiff team attended the court hearing last week. Cengiz said the primary purpose of the plaintiff lawyers, who are working pro bono, was to create a legal “common eye” that is watching all related cases such as Ergenekon and the murder of Hrant Dink, editor of Armenian newspaper Agos, who was murdered months before the three Christians in Malatya.

But the plaintiff lawyers pointed out that very few international bodies and foreign press members are actively monitoring the case, even though in their estimation the Malatya murders are directly linked to uncovering deep elements of Turkish corruption.

“This case has tremendous implications for democracy and deep-state elements in Turkey,” said Cengiz, who has received numerous threats since the beginning of the trial and lives under 24-hour protection.

“What we have here is a concrete act of the Ergenekon gang and it’s interesting.”  

Report from Compass Direct News