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2.
Health Promot Chronic Dis Prev Can ; 42(2): 60-67, 2022 02 16.
Article in English, French | MEDLINE | ID: covidwho-1761569

ABSTRACT

INTRODUCTION: The COVID-19 pandemic and governmental responses have raised concerns about any corresponding rise in suicide and/or drug toxicity mortality due to exacerbations of mental illness, economic issues, changes to drug supply, ability to access harm reduction services, and other factors. METHODS: Data were obtained from the Nova Scotia Medical Examiner Service. Case definitions were developed, and their performance characteristics assessed. Pre-pandemic trends in monthly suicide and drug toxicity deaths were modelled and the observed numbers of deaths in the pandemic year compared to expected numbers. RESULTS: There was a significant reduction in suicide deaths in the first year of the COVID-19 pandemic in Nova Scotia, with about 21 fewer non-drug toxicity suicide deaths than expected in March 2020 to February 2021 (risk ratio = 0.82). No change in drug toxicity mortality was detected. Case definitions were successfully applied to free-text cause of death statements and cases where cause and manner of death remained under investigation. CONCLUSION: Processes for case classification and monitoring can be implemented in collaboration with medical examiners/coroners for timely, ongoing public health surveillance of suicide and drug toxicity mortality. Medical examiners and coroners are the stewards of a wealth of data that could inform the prevention of further deaths; it is time to engage these systems in public health surveillance.


Subject(s)
COVID-19 , Drug-Related Side Effects and Adverse Reactions , Suicide , Coroners and Medical Examiners , Humans , Nova Scotia/epidemiology , Pandemics , Public Health , SARS-CoV-2 , Suicide/prevention & control
3.
J Occup Environ Hyg ; 19(5): 256-265, 2022 05.
Article in English | MEDLINE | ID: covidwho-1730512

ABSTRACT

Like their counterparts in healthcare, workers in medical examiner and coroners' offices are considered essential workers. The frequency and urgency of their work during the coronavirus disease 2019 (COVID-19) pandemic have only become of greater importance. Because of the increased mortality in the general population due to SARS-CoV-2, the virus that causes COVID-19, it is reasonable to assume that the workload and risk of occupational exposure to SARS-CoV-2 have increased for these workers who are required by state law to investigate deaths known or suspected to be due to a contagious disease that constitutes a public hazard. Studies investigating the impact of the COVID-19 pandemic on these workers and their operations have been limited. The objective of this study was to conduct an assessment of routine medical examiner and coroners' office duties (e.g., infectious disease testing and decedent transport) by surveying the 67 county medical examiner and coroners' offices in Pennsylvania to characterize how the rise in infectious disease cases from COVID-19 influenced workload and resource needs. Quantitative results demonstrated an increase in workload and use of personal protective equipment (PPE) while engineering control usage remained the same. Qualitative results revealed various challenges experienced by the offices during the pandemic including limitations in access to PPE, insufficient storage space for increased numbers of decedents, personnel shortage/burnout, and limited or no engagement at the state level for emergency response planning and implementation. These data are valuable to inform the need for additional guidance or supplies and may be used to optimize resource planning and implementation (e.g., personnel, facilities, and supplies) for both routine and surge demand scenarios.


Subject(s)
COVID-19 , Occupational Exposure , COVID-19/epidemiology , Coroners and Medical Examiners , Health Personnel , Humans , Occupational Exposure/prevention & control , Pandemics/prevention & control , Pennsylvania/epidemiology , Personal Protective Equipment , SARS-CoV-2
4.
Am J Forensic Med Pathol ; 43(2): 101-104, 2022 Jun 01.
Article in English | MEDLINE | ID: covidwho-1672430

ABSTRACT

ABSTRACT: The public health role of a medical examiner office (MEO) in a pandemic is largely undefined; however, death data may be useful in strategic planning. Deaths reportable to MEO are defined in statute, with discretion as to the assumption of jurisdiction. We analyzed the daily reported death numbers (DRDNs) in our jurisdiction from March 1, 2020, to March 31, 2021, and compared them with hospital admission and COVID-19 fatality data over the same period. The DRDN from an MEO is easily obtained and may be useful as a supplemental and surrogate metric in certain pandemic mass casualty decisions. Hospital admission data were analyzed in real time and with a 2-week time-shift, as deaths lag hospital admissions as a disease surveillance metric. Moderate correlation was observed between DRDN and hospital admissions (r = 0.570), and this improved to strong correlation (0.645) when the 2-week time-shift was incorporated into the analysis. Both evaluations were statistically significant (P < 0.0001). The DRDN also moderately correlated (r = 0.412) with the number of COVID-19 deaths. Because death certification and hospital diagnosis may be delayed, real-time trend recognition in a pandemic may benefit from use of DRDN from MEO.


Subject(s)
COVID-19 , Mass Casualty Incidents , Coroners and Medical Examiners , Humans , Public Health , SARS-CoV-2
5.
BMJ Evid Based Med ; 27(5): 296-304, 2022 10.
Article in English | MEDLINE | ID: covidwho-1583130

ABSTRACT

OBJECTIVES: To examine coroners' Prevention of Future Deaths (PFDs) reports to identify deaths involving SARS-CoV-2 that coroners deemed preventable. DESIGN: Consecutive case series. SETTING: England and Wales. PARTICIPANTS: Patients reported in 510 PFDs dated between 01 January 2020 and 28 June 2021, collected from the UK's Courts and Tribunals Judiciary website using web scraping to create an openly available database: https://preventabledeathstrackernet/. MAIN OUTCOME MEASURES: Concerns reported by coroners. RESULTS: SARS-CoV-2 was involved in 23 deaths reported by coroners in PFDs. Twelve deaths were indirectly related to the COVID-19 pandemic, defined as those that were not medically caused by SARS-CoV-2, but were associated with mitigation measures. In 11 cases, the coroner explicitly reported that COVID-19 had directly caused death. There was geographical variation in the reporting of PFDs; most (39%) were written by coroners in the North West of England. The coroners raised 56 concerns, problems in communication being the most common (30%), followed by failure to follow protocols (23%). Organisations in the National Health Service were sent the most PFDs (51%), followed by the government (26%), but responses to PFDs by these organisations were poor. CONCLUSIONS: PFDs contain a rich source of information on preventable deaths that has previously been difficult to examine systematically. Our openly available tool (https://preventabledeathstracker.net/) streamlines this process and has identified many concerns raised by coroners that should be addressed during the government's inquiry into the handling of the COVID-19 pandemic, so that mistakes made are less likely to be repeated. STUDY PROTOCOL PREREGISTRATION: https://osf.io/bfypc/.


Subject(s)
COVID-19 , Coroners and Medical Examiners , Cause of Death , England/epidemiology , Humans , Pandemics/prevention & control , SARS-CoV-2 , State Medicine , Wales/epidemiology
7.
Clin Infect Dis ; 72(10): e580-e585, 2021 05 18.
Article in English | MEDLINE | ID: covidwho-1232196

ABSTRACT

BACKGROUND: Given the challenges in implementing widespread testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there is increasing interest in alternative surveillance strategies. METHODS: We tested nasopharyngeal swabs from 1094 decedents in the Wayne County Medical Examiner's Office for SARS-CoV-2. All decedents were assessed using a coronavirus disease 2019 (COVID-19) checklist, and decedents flagged using the checklist (298) were preferentially tested. A random sample of decedents not flagged using the checklist were also tested (796). We statistically analyzed the characteristics of decedents (age, sex, race, and manner of death), differentiating between those flagged using the checklist and not and between those SARS-CoV-2-positive and not. RESULTS: A larger percentage of decedents overall were male (70% vs 48%) and black (55% vs 36%) compared with the catchment population. Seven-day average percent positivity among flagged decedents closely matched the trajectory of percent positivity in the catchment population, particularly during the peak of the outbreak (March and April 2020). After a lull in May to mid-June, new positive tests in late June coincided with increased case detection in the catchment. We found large racial disparities in test results; SARS-CoV-2-positive decedents were substantially more likely to be black than SARS-CoV-2-negative decedents (82% vs 51%). SARS-CoV-2-positive decedents were also more likely to be older and to have died of natural causes, including of COVID-19 disease. CONCLUSIONS: Disease surveillance through medical examiners and coroners could supplement other forms of surveillance and serve as a possible early outbreak warning sign.


Subject(s)
COVID-19 , SARS-CoV-2 , African Americans , Coroners and Medical Examiners , Disease Outbreaks , Female , Humans , Male
8.
Arch Pathol Lab Med ; 145(4): 407-414, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1194781

ABSTRACT

CONTEXT.­: Autopsy pathologists, including medical examiners, provide valuable public health support for infectious disease deaths through surveillance for deaths of public health concern including emerging infections, identifying causative organisms for unexplained deaths, and providing insights into the pathology and pathogenesis of novel or unusual infections. However, autopsy poses biosafety risks to workers within and outside the laboratory. The highest rates of laboratory-acquired infections occur in autopsy workers. OBJECTIVE.­: To design and construct an appropriately biosafe autopsy laboratory. DESIGN.­: We conducted a biosafety risk assessment for autopsy workers using the process developed by the US Centers for Disease Control and Prevention and National Institutes of Health and applied these findings as the basis of laboratory design and construction. RESULTS.­: Autopsy workers are unpredictably exposed to a variety of infectious organisms, including hepatitis C virus, HIV, and Mycobacterium tuberculosis. Hazardous autopsy procedures include using and encountering sharp objects and the generation of aerosols from dissection, fluid aspiration, rinsing tissues, and dividing bone with an oscillating saw. CONCLUSIONS.­: Exposure to blood-borne and airborne pathogens from procedures that can cause cutaneous inoculation and inhalation of aerosols indicates that human autopsies should be performed at biosafety level 3. We designed a large, entirely biosafety level 3 medical examiner autopsy laboratory using design principles and characteristics that can be scaled to accommodate smaller academic or other hospital-based autopsy spaces. Containment was achieved through a concentric ring design, with access control at interface zones. As new autopsy laboratories are planned, we strongly recommend that they be designed to function uniformly at biosafety level 3.


Subject(s)
Autopsy , Communicable Diseases/transmission , Containment of Biohazards , Facility Design and Construction , Infection Control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Laboratories , Occupational Exposure/prevention & control , Coroners and Medical Examiners , Humans , Laboratory Personnel , Occupational Exposure/adverse effects , Occupational Health , Risk Assessment , Risk Factors , Safety Management
10.
BMJ ; 372: n529, 2021 02 24.
Article in English | MEDLINE | ID: covidwho-1102170
11.
Forensic Sci Med Pathol ; 17(2): 262-270, 2021 06.
Article in English | MEDLINE | ID: covidwho-1083033

ABSTRACT

Italy and the United States are two of the countries most affected by SARS-CoV-2 (COVID-19), with more than 240,760 confirmed cases in Italy and 2,699,658 in the United States (as of July 2, 2020). The current COVID-19 pandemic has led to substantial changes in many fields of medicine, specifically in the forensic discipline. Medicolegal activities related to conducting autopsies have been largely affected by the COVID-19 pandemic. Postmortem examinations are generally discouraged by government regulations due to the risk of spreading the disease further through the handling and dissection of bodies from patients who succumbed to COVID-19 infection. There is a paucity of data regarding the persistence of SARS-CoV-2 in bodies, as well as concerning the reliability of swabbing methods in human remains. On the other hand, the autopsy is an essential tool to provide necessary information about the pathophysiology of the disease that presents useful clinical and epidemiological insights. On this basis, we aim to address issues concerning general medical examiner/coroner organization, comparing the Italian and American systems. We also discuss the pivotal roles of forensic pathologists in informing infectious disease surveillance. Finally, we focus on the impact of COVID-19 emergency on medicolegal practices in Italy and the United States, as well as the responses of the forensic scientific community to the emerging concerns related to the pandemic. We believe that stronger efforts by authorities are necessary to facilitate completing postmortem examinations, as data derived from such assessments are expected to be paramount to improving patient management and disease prevention.


Subject(s)
COVID-19/epidemiology , Coroners and Medical Examiners , Professional Role , Autopsy , Communicable Diseases/epidemiology , Death Certificates , Disease Transmission, Infectious/prevention & control , Epidemiological Monitoring , Humans , Infection Control/standards , Italy/epidemiology , Pandemics , United States/epidemiology
12.
J Forensic Leg Med ; 76: 102072, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-920369

ABSTRACT

All Covid-19 deaths and all nursing home and residential home deaths in Ireland must by law be reported to the Coroner, the independent Judicial Officer of the State, in the District in which they occur. This enables accurate and early collation of these death reports. Between January 1, 2015 and June 30, 2020 3342 deaths were reported to the Coroner's District for Kildare. From March 11, 2020, when the first Covid-19 death occurred in Ireland in County Kildare, to June 30, 2020 there were 1738 Covid-19 deaths nationally of which 139 were reported in Kildare with 113 (81%) of these deaths in nursing and residential homes. The calculated excess number of deaths notified for January to June 2020 compared with 2015-2019 was 198 (41%) of the 484 total deaths reported with a 131 (45%) excess in the 293 deaths in nursing and residential homes. Covid-19 deaths accounted for 70% and 86% of these excess deaths respectively. Following subtraction of the 18 non-natural cause deaths and 139 Covid-19 deaths from the total excess there remained an unexplained excess of 60 deaths due to natural causes in March to June of 2020 compared with 2015-2019. The peak excess total death percentage was 359% in April 2020, commencing with a small excess in March (30%), continuing into May (63%) and falling again in June (37%). In the nursing and residential home setting those excess death percentages were most marked at 527% in April, with 27% in March, 54% in May and 17% in June. Underlying medical conditions were recorded in 99% of those dying from Covid-19 and the average age of the deceased was 82.5 years with median of 78 years and 55% of those dying were female and 45% male. The clinical epidemiology and documented excess mortality of the reported deaths are chronicled and analysed to learn also about the future challenges with the continuing Covid-19 infection. A centralized national mortality database providing near real-time death certification enhances infectious disease surveillance and prompt clinical epidemiology and mortality excess studies and reduces under-reporting of Covid-19 deaths.


Subject(s)
Betacoronavirus , Coronavirus Infections/mortality , Pneumonia, Viral/mortality , Registries/statistics & numerical data , Adult , COVID-19 , Cause of Death , Coroners and Medical Examiners , Databases, Factual , Death Certificates , Female , Humans , Ireland/epidemiology , Male , Pandemics , SARS-CoV-2
13.
Occup Med (Lond) ; 70(7): 515-522, 2020 10 27.
Article in English | MEDLINE | ID: covidwho-780420

ABSTRACT

BACKGROUND: By law, covid-19 disease and deaths in workers may lead to coroners' inquests and/or Health and Safety Executive (HSE) investigations. AIMS: This study assesses the adequacy of these statutory means to yield recommendations for prevention of acquiring covid-19 infection from work. METHODS: Covid-19 guidance from the chief coroner and the HSE was appraised, including using Office for National Statistics (ONS) data. Practitioners were asked to estimate the likelihood that covid-19 disease may have arisen from 'near-miss' scenarios. Data from the judiciary and the HSE were analysed. RESULTS: The coroners' guidance allowed a wider range of reports of death than did the HSE and conformed better with ONS data on covid-19 mortality by occupation. In the practitioner survey, 62 respondents considered a higher likelihood that reported covid-19 cases would have arisen from the scenario deemed unreportable as a 'dangerous occurrence' by HSE than the reportable scenario (P < 0.001). On average there was only one coroner's report to prevent future death from occupational disease every year in England and Wales. The HSE dealt with a yearly average of 1611 reports of work-related disease including 104 on biological agents, but has received about 9000 covid-19 reports. CONCLUSIONS: Current HSE guidance for reporting work-related covid-19 may miss many thousands of cases and needs further iteration. Coroners have very limited experience of inquiry into occupational disease caused by biological agents compared with the HSE. Concerns regarding national policy such as on protective equipment warrant a full public inquiry.


Subject(s)
Betacoronavirus , Cause of Death , Coronavirus Infections/mortality , Occupational Diseases/mortality , Occupational Exposure/analysis , Occupational Health , Pneumonia, Viral/mortality , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Coroners and Medical Examiners , Disease Notification , Humans , Occupational Diseases/diagnosis , Occupational Diseases/prevention & control , Occupational Exposure/adverse effects , Occupational Exposure/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , SARS-CoV-2 , United Kingdom/epidemiology
15.
J Forensic Leg Med ; 74: 102028, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-651346

ABSTRACT

COVID-19 has swamped the entire world and turned into a pandemic. Its high contagiousness compelled authorities to categorize all autopsies as 'high risk' considering the risk of exposure to the healthcare workers. In India, the Criminal Procedure Code authorizes investigating police officer to hold an inquest into suspicious deaths. The present article draw attention towards the 'needless autopsies' in times of COVID-19 and emphasizes on causes and recommendations.


Subject(s)
Autopsy/standards , Coronavirus Infections/epidemiology , Coroners and Medical Examiners/organization & administration , Pneumonia, Viral/epidemiology , Police/legislation & jurisprudence , Betacoronavirus , COVID-19 , Coroners and Medical Examiners/legislation & jurisprudence , Coroners and Medical Examiners/standards , Humans , India , Pandemics , Personal Protective Equipment , SARS-CoV-2
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