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28.04.2020 Feature Article

Are People Really Dying Of Covid-19 Or Dying With Covid-19

Are People Really Dying Of Covid-19 Or Dying With Covid-19
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Corona virus 2019, also known as SARS-CoV-2, n-CoV-2019 or COVID-19 is a pandemic that has infected over 2.9 million people worldwide and killed nearly 190,000 people. The disease comes from the corona virus family that is responsible for common cold, severe acute respiratory syndrome (SARS) and the middle east respiratory syndrome (MERS). This new stand of the corona virus is believed to attack the upper respiratory system including the nasal canal, throat and the lungs of the infected person. Hence, governments and mass media platforms have all propagated stay at home campaigns, sensitizing people on the need to put on face mask and the need for regular handwashing and use of alcohol-based sanitizers. Despite all of these efforts, some people who get infected by the virus end up dying. Initially, the death toll was highest in China as that was where the disease originated. However, we have seen a shift from China to Spain, then to Italy and now it is the US.

As I gaze on reports from the WHO’s dashboard and from social media platforms, I wonder. With all of these people dying after testing positive for the COVID-19, their death is recorded as due to the disease. However, in reality is this the case? Are people really dying of COVID-19 or they are merely dying with COVID-19. This is what I seek to draw attention to; to understand the mortality dynamics associated with the COVID-19. It is imperative to conceptualize what I mean by dying of and then dying with. In this article, I talk of dying of COVID-19 to mean that the individual died primarily because of the corona virus and not because of underlying conditions. Dying with COVID-19 on the other hand implies that an individual who tests positive of the corona virus dies but owing primarily to underlying health factors and not necessarily the virus.

What we know about the COVID-19 is that it spreads from person to person when droplets of the virus contained in the cough, sneeze or palm of an individual gets in contact with another person. We also know that the disease thrives well in persons with immuno-compromised systems. Thus, individuals with strong immune systems are more to deal with the virus and recover from it while those with compromised or weakened immune systems may suffer advanced stages of the disease and death. Again, it is known that severe and life-threatening forms of the COVID-19 is endemic to the aged (age 65+) as well as people with underlying conditions such as hypertension, asthma, diabetes and poorly managed HIV (CDC, 2020).

My argument is that people die after testing positive of the COVID-19 die with the disease rather than of the disease. This argument is premised on the assumption that, given the infection rate of the disease and the fact that frontline health workers are contracting the disease, many morgues will not run the normal autopsies that they do in the case of a presumed “died of COVID-19”. As a matter of personal protection, particularly in the Western world where the deaths outmatched the morgues, traditional autopsies will be overlooked and a hasty autopsy that relies heavily on the findings of the medical officers that treated the deceased will be adopted. Hence, failing to substantively declare that indeed, the deceased died of COVID-19.

Death from COVID-19 may be quite elusive in nature but it has these characteristics that assists in the autopsy analysis. According to Gibbs and Mirsky (2020) in their close transcript with Desiree Marshall, a pathologist at the University of Washington and Sanjay Mukhopadhyay, director of pulmonary pathology at the Cleveland Clinic, it says that, when COVID-19 attacks the human body, it “starts causing damage where it attaches first, which is the back of the throat, and then all the way down the windpipe, down the branches, to the smallest branches and then into the air sacs. And when it gets into the air sacs, we call that a viral pneumonia. The virus is damaging the walls of the air sacs.” Mukhopadhyay also added that the modus operandi of the virus are to cause diffuse alveolar damage, also known as acute respiratory distress syndrome (ARDS). Hence, the pathological characteristic of the virus is known.

Mukhopadhyay asserts that a patient who tested positive for the COVID-19 and died was later examined in a high containment facility where it was realized that he actually died of aspiration pneumonia and not the corona virus because there was no diffuse alveolar damage. This raises concern as to how often such instances happen. In the words of Mukhopadhyay he asks, “How often are people who are positive for COVID on a nasal swab dying of things other than COVID?” This is a critical question that must gain the attention of the health ministries and the World Health Organization. How certain are we that indeed those reported to have died of COVID-19 actually did die of that? This is a question that only empirical, scientific tests and studies can establish.

Knowing this will be critical in informing how confirmed cases are managed and treated. For all we know, you only have to treat the concomitant underlying ailment rather than attempting to fight the virus. Again, knowledge about how conclusive it is that people who die after contracting COVID-19 of the disease will go a long way to reduce the fears and anxiety persons with increased risk of catching the disease like in the case of asthmatics and hypertensives. If the opposite is found to be true in the majority of cases, then it will inform the government and health care systems to prioritize non-communicable diseases in order to prevent future resurgence of the pandemic.

Reference

  1. Centers for Disease Control and Prevention (CDC) (2020). Coronavirus Disease 2019 (COVID-19). Accessed from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html
  2. Gibbs, W. W. & Mirsky, S. (2020). COVID-19: What the Autopsies Reveal. Accessed from: https://www.scientificamerican.com/podcast/episode/covid-19-what-the-autopsies-reveal/?fbclid=IwAR2PWCJVNJ9bH_9Jv33b9iN6q60PbrD4bZzgiIXKRAzGn1UjeN8eL5NG1qk

Joshua Okyere
Joshua Okyere, © 2020

The author has 29 publications published on Modern Ghana.Column: JoshuaOkyere

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