‘Systematic reviews’ to discover true cause of outbreak deaths

The Royal College of Pathologists’ comments come amid concern over the uncertainty about the cause of the large numbers of deaths taking place. There is uncertainty about whether they are being correctly attributed to virus, and whether some have died as a knock-on effect of the response to covid-19.

It leaves many in the dark about the circumstances of the deaths of family and friends.

The college said there should be “systematic reviews” into issues such as personal protective equipment supplies, body storage, outbreak planning, delaying elective surgery, and background screening for the virus.

However, Mike Osborn, Royal College of Pathologists’ adviser on post mortems and cellular pathology, told HSJ this would not happen soon, with different agencies — such as the Care Quality Commission, Public Health England and medical royal colleges — needing to lead reviews in their respective areas.

Dr Osborn said: “The college would support appropriate, systematic reviews, possibly in the autumn when things may have returned to ‘normal’. Issues that could be considered could include background screening, the effects of delaying normal practice, elective surgery, deliveries of personal protective equipment, body storage and outbreak planning.”

He indicated there should be some scrutiny of care quality at the moment, however, while the outbreak is ongoing. He said: ”We would expect all efforts to be taken to maintain high standards of care during this incredibly pressured time of the covid-19 outbreak. We would support any appropriate reviews of care.”

The college is setting up a database based on deaths to inform treatment and research. Results will be made available to doctors working with people affected by covid-19, the college said.

Meanwhile, the college said guidance had been produced and disseminated for doctors who register deaths during the virus outbreak. There has been concern about variation in whether deaths are being correctly attributed to covid-19 on death certificates.

One GP who contacted HSJ with frustrations about registering deaths of suspected covid-19 patients said: “We are not allowed to put suspected covid-19 on the certificate — we cannot put acute respiratory failure. It means we either have to make the assumption that it is a covid-19 death — we, of course, have no access to testing patients in the community — or use some other cause when we are pretty certain it’s a covid-19 related death.”