Can you tell me if someone tests positive for Coronavirus and dies of a heart attack, what category their death would recorded in?
Thank you for your request.
Doctors are required by law to certify the cause of death 'to the best of their knowledge and belief'. That means they use their medical expertise to decide the cause based on symptoms, physical examination, hospital records, laboratory tests, and all the other information available. If death is certified by a coroner, the Coroner's Court follows legal rules of evidence when deciding the causes of death. For deaths involving COVID-19, whether or not there was a positive test result is only one piece of information to be taken into account, alongside the patient's symptoms and other evidence. COVID-19 is only mentioned on the death certificate if the doctor or coroner believes it was part of the reason the person died. A positive test result does not make a death 'count' as involving COVID-19 if COVID-19 did not actually contribute to the death, for example if the person died in an accident.
Our data as described here are different from the figures on COVID-19 deaths published on the government's COVID-19 dashboard which shows 'deaths within 28 days of a positive test'. You can read a blog by Professor John Newton of Public Health England about the complexities of counting COVID-19 deaths and the different methods used.
The doctor or coroner certifying a death can record more than one health condition or event on the form. The medical certificate of cause of death has two parts, Part 1 contains the sequence of health conditions or events leading directly to death, while Part 2 can contain other health conditions that contributed to the death but were not part of the direct sequence. For statistical purposes one of the health conditions on the certificate is chosen as the 'underlying cause of death'. The underlying cause of death is defined as the health condition or event that started the train of events leading to death and is worked out according to rules from the World Health Organisation (WHO).
You can read in detail about the coding of causes of death and identifying the underlying cause in the ONS User guide to mortality statistics and the WHO International Classification of Diseases (ICD-10) instruction manual.
So, in this hypothetical case, the cause of death may be recorded under an ICD-10 code related to Heart Disease or cardiac arrest, with COVID-19 as a contributory cause, if the doctor felt COVID-19 contributed to the death. However, if it was thought that COVID-19 was not contributory to the death, it would not be recorded on the death certificate regardless of the positive test.