Given that there is a            disease (COVID) now, the thing you need to update your knowledge is:

new  

• ​​WHO has provided a new ICD code for Coronavirus Disease 2019 (COVID-19) – U07.1

• ​The WHO has also provided a second code, U07.2, for clinical or epidemiological diagnosis of COVID-19 where a laboratory confirmation is not available

​​Let us consider first set of scenarios

• ​Person with symptoms (3 days of fever and dry cough and 1 day of breathlessness) and who had recently attended a mass gathering presented to a hospital; here, he had a nasal swab done and was hospitalized

Patient 1

• ​The report came as COVID positive

• ​The patient quickly deteriorated to have a pneumonia and then within few days developed sepsis and then died

• ​Person with symptoms (3 days of fever and dry cough and 1 day of breathlessness) who had prolonged contact with a known COVID patient came to the hospital; here, she had a nasal swab done and was hospitalized

Patient 2

• ​The report came as COVID positive

• ​The patient quickly deteriorated to have a pneumonia and then within few days developed adult respiratory distress syndrome in the ICU  and then died

• ​This patient also had other pre-existing co-morbidities and also reported that this COPD was not responding to his usual medicines​

• Step 3 - Fill in a death certificate with the appropriate diagnoses and codes in both cases

• Step 1- Construct biological sequence of events to identify Underlying, Intermediate and Immediate Cause of Death

• Step 2 - Assign appropriate ICD code 

Patient 1

• Step 1- Construct biological sequence of events to identify Underlying, Intermediate and Immediate Cause of Death

Patient 1

Patient 2

• Step 1- Construct biological sequence of events to identify Underlying, Intermediate and Immediate Cause of Death

Patient 2

​​Now let us consider the second set of scenarios

• ​A known case of Ca-breast and a past history of ischaemic heart diseases was admitted in the hospital

Patient 3

• ​She was diagnosed to have metastatic disease of brain, bone and kidneys

• ​Meanwhile, she also underwent a test for COVID (with no relevant contact history or fever or chest symptoms) and was found to be positive​

• She died in the ward due to her extensive metastatic disease

• ​A pregnant woman was brought to the hospital with obstructed labour followed by uterine rupture and then prolonged haemorrhage

Patient 4

• Meanwhile, she also underwent a test for COVID (with no relevant contact history or fever or chest symptoms) and was found to be positive​

• She died in the ward due to obstetric hemorrhage

Patient 3

• Step 1- Construct biological sequence of events to identify Underlying, Intermediate and Immediate Cause of Death

Patient 3

Patient 4

• Step 1- Construct biological sequence of events to identify Underlying, Intermediate and Immediate Cause of Death

Patient 4

​​Filling death certificate…if lab confirmation for COVID is

​​unavailable

Clinicians may also suspect COVID in some of their patients because of the typical illness, but lab testing and confirmation may be delayed or unavailable. In such cases, they can use another code offered by W.H.O. This is described in next set of slides

Patient 5

• Step 1- Construct biological sequence of events to identify Underlying, Intermediate and Immediate Cause of Death

Patient 5

Note -

COVID, virus not identified is alternately called as COVID suspect or probable COVID

Patient 6

• Step 1- Construct biological sequence of events to identify Underlying, Intermediate and Immediate Cause of Death

Patient 6

Note -

COVID, virus not identified is alternately called as COVID suspect or probable COVID

• While the W.H.O. has specified codes for the COVID itself, there are no specific codes for the complications caused by COVID

You’ll notice that…

• Meanwhile, do remember to place COVID either as an underlying CoD in Part I or as only a contributory cause in Part II

it is important to remember that not all physicians and medical records personnel may be aware of these new U-codes created by the World Health Organization (W.H.O.) for COVID-19 and may therefore be using the old coding convention for the diagnosis of pneumonias or severe acute respiratory illnesses (SARIs)….as seen in examples in the next slide!

However

​​If Pneumonias/LRIs are not being specifically captured as COVID…

Patient 7

Patient 8

Patient 9

​​You’ll also notice that…

We are breaking our usual conventions…such as not using abbreviations…but since COVID is widely known now and that it is extreme circumstances such as an on-going pandemic now….this is OK for now!

​​‘Dying of COVID’ and ‘dying with COVID’

• If a person has COVID listed in Part I, that death is included as ‘dying of COVID’; if a person has COVID listed in Part II, then that person is included as ‘dying with COVID’

​​COVID-related deaths

• While in normal practice, a cause-of-death is taken only when it is mentioned in the lowest filled line in Part I (and not in Part II), during an epidemic such as the on-going pandemic, it is possible that countries and other jurisdictions will add up all deaths where COVID is mentioned either in Part I or in Part II and then club them all together as COVID-related deaths

​​COVID-related deaths

• For instance, if there are 1000 death certificates filled with COVID in Part I and another 500 death certificates filled with COVID in Part II and multiple other illnesses in Part I, COVID-related deaths will be taken as 1500 (and not 1000)       the logic here being that these 500 deaths wouldn’t have occurred now but for the COVID epidemic [this is because this is a pandemic; otherwise, we wouldn’t be doing this for other diseases]

• In addition to persons dying of/with COVID, it is also important to remember that other avoidable deaths will also be occurring during a pandemic

​​Other pandemic associated deaths

• these will not be included as COVID deaths but health systems should be prepared for such deaths as well. These should be coded as per usual procedure as suicide or alcohol poisoning or neonatal death, etc.

• Examples of such deaths are shown in the next slide

​​Other pandemic associated deaths

References

• https:WHO. ICD-10 Version 2019. Available at: https://icd.who.int/browse10/2019/en#/U00-U49   [accessed: 09-Apr-2020]

• Ministry of Health & Family Welfare. Govt of India. COVID-19 India update. Available at: https://www.mohfw.gov.in/  [accessed: 09-Apr-2020]
• Centers for Disease Control and Prevention. National Vital Statistics System. U.S. Department of Health and Human Services. Hyattsville, MD. Available at: https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf                              [accessed: 09-Apr-2020]
• Scottish Government. Death certification during an influenza pandemic: Chief Medical Officer guidance. 13 Feb 2017. Available at: https://www.gov.scot/publications/death-certification-during-an-influenza-pandemic-chief-medical-officer-guidance/    [accessed: 09-Apr-2020]

• Lee J. How to understand – and report – figures for ‘Covid deaths’. The Spectator (the 10,000th issue). Available at: https://www.spectator.co.uk/article/how-to-understand-and-figures-for-covid-19-deaths-(accessed 25 Apr 2020)