In China, doctors say they are discouraged from citing COVID on death certificates

BEIJING, Jan 17 (Reuters) – During a busy shift at the height of Beijing’s Covid wave, a doctor at a private hospital saw a printed notice in the emergency department: DOCTORS TO DEATH FROM COVID-INDUCED RESPIRATORY FAILURE One should “not try” to write. certificate

Instead, if the deceased had an underlying disease, it must be named as the main cause of death, according to the notice, a copy of which was seen by Reuters.

If doctors believe the death is solely due to Covid-19 pneumonia, they should report to their superiors, who will arrange two levels of “expert consultation” before a Covid death can be confirmed. It says

Six doctors at state-run hospitals across China told Reuters they either received verbal instructions discouraging them from attributing deaths to Covid or were aware their hospitals had such policies.

Some relatives of people who died of Covid say the disease did not appear on their death certificates, and some patients have reported not being tested for the coronavirus despite arriving with respiratory symptoms.

“We stopped classifying Covid deaths after we reopened in December,” said a doctor at a major public hospital in Shanghai. “It’s useless to do that because almost everyone is positive.”

Such directives have drawn criticism from global health experts and the World Health Organization that China has underreported Covid deaths as the coronavirus continues to spread rapidly in the country, which abandoned its strict “zero-Covid” regime in December. had given

On Saturday, officials said 60,000 people have died of Covid-19 in hospitals since China’s policy U-turn, a nearly 10-fold increase from previously reported figures, but still below international experts’ expectations. are, who have said that China can see more than that. One million Covid-related deaths this year.

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China’s Centers for Disease Control (CDC) and National Health Commission (NHC) did not immediately respond to Reuters requests for comment.

The doctors declined to be named in this article because they are not authorized to speak to the media.

Several said they were told such a directive came from “the government,” although no one knew from which department, a common situation in China when politically sensitive directives are disseminated.

Three other doctors from government hospitals in different cities said they were unaware of any such guidelines.

One of them, a senior emergency room doctor in Shandong province, said doctors are issuing death certificates based on the actual cause of death, but “how to classify” those deaths is up to hospitals or local authorities. is

‘looks less’

Since the start of the epidemic, which first emerged in its central city of Wuhan three years ago, China has drawn heavy criticism for its lack of transparency about the virus – an accusation it has repeatedly denied.

Before Saturday, China was reporting five or fewer Covid deaths per day. Of the nearly 60,000 Covid-related deaths announced on Saturday since December 8, less than 10% were due to respiratory failure caused by Covid. Jiao Yahui, head of the Bureau of Medical Administration under the National Health Commission (NHC), said on Saturday that the rest are the result of a combination of Covid and other diseases.

Michael Baker, a public health scholar at the University of Otago in New Zealand, said the updated death toll still “looks low” compared to the high level of infection in China.

“Most countries are finding that most deaths from Covid are directly caused by the infection rather than a combination of Covid and other diseases,” he said. “In contrast, reported deaths in China are predominantly (90%) a combination of Covid and other infections, which also suggests that deaths directly attributable to Covid infection are underreported in China. .”

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Yanzhong Huang, senior fellow in global health at the Council on Foreign Relations in New York, said it was unclear whether the new data reflected actual deaths, in part because the numbers included only deaths in hospitals.

The World Health Organization (WHO) on Monday recommended that China monitor more death rates to get a fuller picture of the impact of the surge in Covid.

Excess mortality occurs when the number of deaths for a given period is higher than the historical average.

Testing ends

Seven people told Reuters that the death certificates of their recently deceased relatives did not mention Covid, even though the relatives had either tested positive for the virus or displayed Covid-like symptoms.

Social media is full of such news.

When a Beijing resident surnamed Yao brought her Covid-positive 87-year-old aunt to a major government hospital late last month with breathing difficulties, doctors did not ask if she had the virus or mention Covid. Done, Yao said.

“The hospital was full of patients, all in their 80s or 90s, and the doctors didn’t have time to talk to anyone,” Yao said, noting that everyone showed Covid-like symptoms.

The patients, including his aunt, were rigorously tested, though not for Covid, before being told they had pneumonia. But the hospital told him that his medicine had run out, so they could only go home.

After ten days she recovered.

Medical staff at public hospitals in several Chinese cities said PCR testing, which was a daily requirement for large sections of the population under “Zero Covid”, has now been abandoned.

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Shifting focus from testing may be the best way to maximize resources when hospitals are overwhelmed, two experts told Reuters.

Ben Cowling, an epidemiologist at the University of Hong Kong, said almost all patients with severe respiratory problems will have Covid: “Because antivirals are in short supply, I don’t think laboratory testing will make much of a difference in case management.”

‘be careful’

A senior doctor in the eastern city of Ningbo said doctors there had been told to be “careful” about saying someone had died of Covid, but would need to get approval if they wanted to do so. .

No other disease requires the same level of “caution” for entry on a death certificate, he said.

A doctor at a major public hospital in Shanghai said the weekly death rate after the recent Covid wave was three or four times higher than normal for this time of year. Many had multiple illnesses, but Covid worsened their conditions, he said.

“On the death certificate we fill in one main cause of death and two to three sub-causes of death, so we actually leave out Covid,” he said.

“We have no other option but to follow the orders given by the hospital, which come from the government. I am not too important to take any decision,” he said.

Reporting by Martin Quinn Pollard in Beijing and Anjen Tham in Shanghai. Additional reporting by Brenda Goh in Shanghai and Hong Kong, Shanghai and Beijing newsrooms; Editing by Tony Munro and Gary Doyle

Our Standards: The Thomson Reuters Trust Principles.


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