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1.
PLoS One ; 17(3): e0264769, 2022.
Article in English | MEDLINE | ID: covidwho-1745318

ABSTRACT

Using the synthetic control method, we construct counterfactuals for what would have happened if Sweden had imposed a lockdown during the first wave of the COVID-19 epidemic. We consider eight different indicators, including a novel one that we construct by adjusting recorded daily COVID-19 deaths to account for weakly excess mortality. Correcting for data problems and re-optimizing the synthetic control for each indicator, we find that a lockdown would have had sizable effects within one week. The much longer delay estimated by two previous studies focusing on the number of positives cases is mainly driven by the extremely low testing frequency that prevailed in Sweden in the first months of the epidemic. This result appears relevant for choosing the timing of future lockdowns and highlights the importance of looking at several indicators to derive robust conclusions. We also find that our novel indicator is effective in correcting errors in the COVID-19 deaths series and that the quantitative effects of the lockdown are stronger than previously estimated.


Subject(s)
COVID-19/mortality , Health Policy , Quarantine/legislation & jurisprudence , Death Certificates , Humans , Sweden/epidemiology
2.
Forensic Sci Med Pathol ; 18(1): 45-56, 2022 03.
Article in English | MEDLINE | ID: covidwho-1669988

ABSTRACT

The COVID-19 pandemic has significantly impacted many aspects of life, including death care. International and national protocols have been implemented for the management of the dead. This study aims to determine the characteristics of decedents managed according to COVID-19 protocols in Indonesia and the quality of their death certificates. This study uses a descriptive, cross-sectional design. Secondary data of deaths with COVID-19 were taken from hospital death registries, medical records, and death certificates. Data were collected from nine referral hospitals and one funeral home in 6 cities in Indonesia. The majority of the decedents were male, Muslim, with a median age of 57. Most were treated in non-intensive isolation wards, and almost half had known comorbidities. Many were still awaiting the result of their confirmative PCR at the time of death. Almost all were managed compliant with the standard protocol, and most were buried in COVID-only cemeteries. There were still deficiencies in the completeness and accuracy of the death certificates. "COVID-19" was mentioned as a cause of death in only about half of the cases, with a wide variety of terms and spelling. Management of the dead protocols for bodies with COVID-19 can generally be implemented in Indonesia. The quality of the death certificates should, however, be continuously improved.


Subject(s)
COVID-19 , Cause of Death , Cross-Sectional Studies , Death Certificates , Female , Humans , Indonesia , Male , Pandemics
3.
BMJ Open ; 11(11): e050361, 2021 11 16.
Article in English | MEDLINE | ID: covidwho-1523004

ABSTRACT

OBJECTIVES: Cause-of-death discrepancies are common in respiratory illness-related mortality. A standard epidemiological metric, excess all-cause death, is unaffected by these discrepancies but provides no actionable policy information when increased all-cause mortality is unexplained by reported specific causes. To assess the contribution of unexplained mortality to the excess death metric, we parsed excess deaths in the COVID-19 pandemic into changes in explained versus unexplained (unreported or unspecified) causes. DESIGN: Retrospective repeated cross-sectional analysis, US death certificate data for six influenza seasons beginning October 2014, comparing population-adjusted historical benchmarks from the previous two, three and five seasons with 2019-2020. SETTING: 48 of 50 states with complete data. PARTICIPANTS: 16.3 million deaths in 312 weeks, reported in categories-all causes, top eight natural causes and respiratory causes including COVID-19. OUTCOME MEASURES: Change in population-adjusted counts of deaths from seasonal benchmarks to 2019-2020, from all causes (ie, total excess deaths) and from explained versus unexplained causes, reported for the season overall and for time periods defined a priori: pandemic awareness (19 January through 28 March); initial pandemic peak (29 March through 30 May) and pandemic post-peak (31 May through 26 September). RESULTS: Depending on seasonal benchmark, 287 957-306 267 excess deaths occurred through September 2020: 179 903 (58.7%-62.5%) attributed to COVID-19; 44 022-49 311 (15.2%-16.1%) to other reported causes; 64 032-77 054 (22.2%-25.2%) unexplained (unspecified or unreported cause). Unexplained deaths constituted 65.2%-72.5% of excess deaths from 19 January to 28 March and 14.1%-16.1% from 29 March through 30 May. CONCLUSIONS: Unexplained mortality contributed substantially to US pandemic period excess deaths. Onset of unexplained mortality in February 2020 coincided with previously reported increases in psychotropic use, suggesting possible psychiatric or injurious causes. Because underlying causes of unexplained deaths may vary by group or region, results suggest excess death calculations provide limited actionable information, supporting previous calls for improved cause-of-death data to support evidence-based policy.


Subject(s)
COVID-19 , Pandemics , Cause of Death , Cross-Sectional Studies , Death Certificates , Humans , Mortality , Retrospective Studies , SARS-CoV-2
4.
Sci Rep ; 11(1): 19952, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-1462028

ABSTRACT

The dynamic characterization of the COVID-19 outbreak is critical to implement effective actions for its control and eradication but the information available at a global scale is not sufficiently reliable to be used directly. Here, we develop a quantitative approach to reliably quantify its temporal evolution and controllability through the integration of multiple data sources, including death records, clinical parametrization of the disease, and demographic data, and we explicitly apply it to countries worldwide, covering 97.4% of the human population, and to states within the United States (US). The validation of the approach shows that it can accurately reproduce the available prevalence data and that it can precisely infer the timing of nonpharmaceutical interventions. The results of the analysis identified general patterns of recession, stabilization, and resurgence. The diversity of dynamic behaviors of the outbreak across countries is paralleled by those of states and territories in the US, converging to remarkably similar global states in both cases. Our results offer precise insights into the dynamics of the outbreak and an efficient avenue for the estimation of the prevalence rates over time.


Subject(s)
COVID-19/epidemiology , Basic Reproduction Number , Computer Simulation , Death Certificates , Demography , Disease Outbreaks , Global Health , Humans , Population Dynamics , SARS-CoV-2/isolation & purification , United States/epidemiology
5.
Am J Public Health ; 111(10): 1839-1846, 2021 10.
Article in English | MEDLINE | ID: covidwho-1435678

ABSTRACT

Objectives. To describe excess mortality during the COVID-19 pandemic in Guatemala during 2020 by week, age, sex, and place of death. Methods. We used mortality data from 2015 to 2020, gathered through the vital registration system of Guatemala. We calculated weekly mortality rates, overall and stratified by age, sex, and place of death. We fitted a generalized additive model to calculate excess deaths, adjusting for seasonality and secular trends and compared excess deaths to the official COVID-19 mortality count. Results. We found an initial decline of 26% in mortality rates during the first weeks of the pandemic in 2020, compared with 2015 to 2019. These declines were sustained through October 2020 for the population younger than 20 years and for deaths in public spaces and returned to normal from July onward in the population aged 20 to 39 years. We found a peak of 73% excess mortality in mid-July, especially in the population aged 40 years or older. We estimated a total of 8036 excess deaths (95% confidence interval = 7935, 8137) in 2020, 46% higher than the official COVID-19 mortality count. Conclusions. The extent of this health crisis is underestimated when COVID-19 confirmed death counts are used. (Am J Public Health. 2021;111(10): 1839-1846. https://doi.org/10.2105/AJPH.2021.306452).


Subject(s)
COVID-19/mortality , Pandemics , Adolescent , Adult , Age Distribution , Aged , Child , Child, Preschool , Death Certificates , Female , Guatemala/epidemiology , Humans , Infant , Male , Middle Aged , Public Health , SARS-CoV-2 , Sex Distribution , Young Adult
6.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz ; 64(9): 1125-1135, 2021 Sep.
Article in German | MEDLINE | ID: covidwho-1358094

ABSTRACT

INTRODUCTION: In light of the current COVID-19 pandemic, the idea arose to conduct a study to comparatively evaluate deaths from two respiratory transmissible infectious diseases (pandemic COVID-19 and seasonal influenza) by means of death certificates received by the health department. METHODS: Death certificates of all deaths in Munich in the death period from 1 March-31 December 2020 were analyzed. The predefined inclusion criteria were the indication of "Corona, COVID-19, SARS-CoV­2, Influenza (A/B)" on the death certificates. Standardized data entry was performed. The collected data were analyzed descriptively in aggregated form. RESULTS: A total of 12,441 persons died during the study period, 1029 (8.3%) from confirmed COVID-19 and 22 (0.1%) from influenza. The two collectives matched well in the parameters studied. The mean age at death was approximately 80 years and the most common site of death was in hospital. Infectious disease was the cause of death in more than 90% of cases. The most common causes of death were acute respiratory distress syndrome/respiratory failure and multiorgan failure. An average of two previous illnesses were reported, most commonly diseases of the circulatory system and nervous system. There was no influenza death in the second pandemic wave. DISCUSSION: In this study, COVID-19- and influenza-associated deaths were compared for the first time. The deaths of both collectives matched well in the parameters studied, but still require verification in a larger study given the small numbers of influenza cases. An English full-text version of this article is available at SpringerLink as Supplementary Information.


Subject(s)
COVID-19 , Death Certificates , Influenza, Human , COVID-19/mortality , Germany/epidemiology , Humans , Influenza, Human/mortality , Pandemics
8.
Sociol Health Illn ; 43(7): 1614-1626, 2021 08.
Article in English | MEDLINE | ID: covidwho-1307659

ABSTRACT

This article explores the emergence and development of Death Certificates as a means of establishing the cause of death for individuals and populations. The difficulty in choosing which disease caused death when several are described on the Certificate explains why the number of COVID-19-related deaths has been difficult to determine. This problem also draws attention to the dominant biomedical explanation for the cause of death that both promote and circumscribe what can be recognised as a valid cause.


Subject(s)
COVID-19 , Pandemics , Cause of Death , Death Certificates , Humans , SARS-CoV-2
9.
Eur Rev Med Pharmacol Sci ; 25(9): 3610-3613, 2021 May.
Article in English | MEDLINE | ID: covidwho-1232733

ABSTRACT

OBJECTIVE: The aim of the study is to assess the impact of the COVID-19 pandemic on causes of mortality through multiple methodological approaches. MATERIALS AND METHODS: The causes of mortality in the Veneto region (Italy) during the first epidemic wave, March-April 2020, were compared with the corresponding months of the previous two years. Both the underlying cause of death (UCOD), and all diseases reported in the death certificate (multiple causes of death) were investigated; a further analysis was carried out through a simulation where the UCOD was selected after substituting ICD-10 codes for COVID with unspecified pneumonia. RESULTS: Overall 10,222 deaths were registered in March-April 2020, corresponding to a 24% increase compared to the previous two years. COVID-19 was mentioned in 1,444 certificates, and selected as the UCOD in 1,207 deaths. Based on the UCOD, the increases in mortality were observed for COVID and related respiratory conditions, diabetes mellitus, hypertensive heart diseases, cerebrovascular diseases, and ill-defined causes. Multiple causes of death and the simulation analysis demonstrated further increases in mortality related to dementia/Alzheimer and chronic lower respiratory diseases. CONCLUSIONS: This first report demonstrates an increase of several causes of death during the pandemic, underlying the need of a continuous surveillance of mortality records through different analytic strategies.


Subject(s)
COVID-19/diagnosis , COVID-19/mortality , Death Certificates , COVID-19/complications , Cause of Death/trends , Diabetes Mellitus/diagnosis , Diabetes Mellitus/mortality , Epidemics , Humans , Italy/epidemiology , Pneumonia/diagnosis , Pneumonia/etiology , Pneumonia/mortality
10.
Am J Public Health ; 111(6): 1123-1131, 2021 06.
Article in English | MEDLINE | ID: covidwho-1186635

ABSTRACT

The complex and evolving picture of COVID-19-related mortality highlights the need for data to guide the response. Yet many countries are struggling to maintain their data systems, including the civil registration system, which is the foundation for detailed and continuously available mortality statistics. We conducted a search of country and development agency Web sites and partner and media reports describing disruptions to the civil registration of births and deaths associated with COVID-19 related restrictions.We found considerable intercountry variation and grouped countries according to the level of disruption to birth and particularly death registration. Only a minority of the 66 countries were able to maintain service continuity during the COVID-19 restrictions. In the majority, a combination of legal and operational challenges resulted in declines in birth and death registration. Few countries established business continuity plans or developed strategies to deal with the backlog when restrictions are lifted.Civil registration systems and the vital statistics they generate must be strengthened as essential services during health emergencies and as core components of the response to COVID-19.


Subject(s)
Birth Certificates , COVID-19 , Death Certificates , Mandatory Reporting , Registries/statistics & numerical data , Vital Statistics , Databases, Factual , Humans , Internationality , Quarantine
11.
MMWR Morb Mortal Wkly Rep ; 70(14): 523-527, 2021 Apr 09.
Article in English | MEDLINE | ID: covidwho-1173073

ABSTRACT

Approximately 375,000 deaths during 2020 were attributed to COVID-19 on death certificates reported to CDC (1). Concerns have been raised that some deaths are being improperly attributed to COVID-19 (2). Analysis of International Classification of Diseases, Tenth Revision (ICD-10) diagnoses on official death certificates might provide an expedient and efficient method to demonstrate whether reported COVID-19 deaths are being overestimated. CDC assessed documentation of diagnoses co-occurring with an ICD-10 code for COVID-19 (U07.1) on U.S. death certificates from 2020 that had been reported to CDC as of February 22, 2021. Among 378,048 death certificates listing U07.1, a total of 357,133 (94.5%) had at least one other ICD-10 code; 20,915 (5.5%) had only U07.1. Overall, 97.3% of 357,133 death certificates with at least one other diagnosis (91.9% of all 378,048 death certificates) were noted to have a co-occurring diagnosis that was a plausible chain-of-event condition (e.g., pneumonia or respiratory failure), a significant contributing condition (e.g., hypertension or diabetes), or both. Overall, 70%-80% of death certificates had both a chain-of-event condition and a significant contributing condition or a chain-of-event condition only; this was noted for adults aged 18-84 years, both males and females, persons of all races and ethnicities, those who died in inpatient and outpatient or emergency department settings, and those whose manner of death was listed as natural. These findings support the accuracy of COVID-19 mortality surveillance in the United States using official death certificates. High-quality documentation of co-occurring diagnoses on the death certificate is essential for a comprehensive and authoritative public record. Continued messaging and training (3) for professionals who complete death certificates remains important as the pandemic progresses. Accurate mortality surveillance is critical for understanding the impact of variants of SARS-CoV-2, the virus that causes COVID-19, and of COVID-19 vaccination and for guiding public health action.


Subject(s)
COVID-19/mortality , Death Certificates , International Classification of Diseases , Public Health Surveillance/methods , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Reproducibility of Results , United States/epidemiology , Young Adult
12.
Lancet Microbe ; 2(4): e130, 2021 04.
Article in English | MEDLINE | ID: covidwho-1156810
13.
Ann Epidemiol ; 58: 69-75, 2021 06.
Article in English | MEDLINE | ID: covidwho-1144483

ABSTRACT

PURPOSE: To examine characteristics of coronavirus disease 2019 (COVID-19) decedents in California (CA) and evaluate for disproportionate mortality across race/ethnicity and ethnicity/nativity. METHODS: COVID-19 deaths were identified from death certificates. Age-adjusted mortality rate ratios (MRR) were compared across race/ethnicity. Proportionate mortality rates (PMR) were compared across race/ethnicity and by ethnicity/nativity. RESULTS: We identified 10,200 COVID-19 deaths in CA occurring February 1 through July 31, 2020. The most frequently observed characteristics among decedents were age 65 years or above, male, Hispanic, foreign-born, and educational attainment of High School or below. MRR indicated elevated COVID-19 morality rates among Asian/Pacific Islander, Black, and Hispanic groups compared with the White group, with Black and Hispanic groups having the highest MRR at 2.75 (95%CI: 2.54-2.97) and 4.18 (95%CI: 3.99-4.37), respectively. Disparities were larger at younger ages. Similar results were observed with PMR, and patterns of age-racial/ethnic disparities remained in analyses stratified by education. Elevated PMR were observed in all ethnicity/nativity groups, especially foreign-born Hispanic individuals, relative to U.S.-born non-Hispanic individuals. These were generally larger at younger ages and persisted after stratifying by education. CONCLUSIONS: Differential COVID-19 mortality was observed in California across racial/ethnic groups and by ethnicity/nativity groups with evidence of greater disparities among younger age groups. Identifying COVID-19 disparities is an initial step toward mitigating disease impacts in vulnerable communities.


Subject(s)
COVID-19 , Aged , California/epidemiology , Death Certificates , Humans , Male , SARS-CoV-2 , United States
15.
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
16.
Expert Rev Anti Infect Ther ; 19(1): 17-21, 2021 01.
Article in English | MEDLINE | ID: covidwho-1066155

ABSTRACT

INTRODUCTION: A Pandemic is an epidemic at a global scale. The word 'epidemic' has the potential to lead to chaotic, unreasoned responses to health problems, especially when used by journalists. Nigeria like other poor resource countries is equally affected by the current coronavirus disease 2019 (COVID-19) pandemic. Standardization and proper documentation of the mortality of the COVID-19 in the poor-resource countries will help in managing other disease outbreaks in future. This paper calls for improvement in capturing of these data for better planning in the future. AREAS COVERED: Quality data is very essential for policy makers to appreciate any disease condition. In order to present a comprehensive picture of COVID-19 mortality, the deaths were broadly grouped into two as follows: direct and indirect COVID-19 deaths. Most of the current reported deaths seem to be direct deaths. EXPERT OPINION: We propose that for better estimation and standardization, verbal autopsy could be used to differentiate direct/indirect COVID deaths. At full development, this model could be applied to other diseases, outbreaks, or pandemics. The disease surveillance officers, and other health workers can be trained in this regard as well as scaling up the e-surveillance of the DSNOs.


Subject(s)
COVID-19/mortality , Documentation , SARS-CoV-2 , Death Certificates , Health Resources , Humans
17.
Int J Epidemiol ; 49(6): 1951-1962, 2021 01 23.
Article in English | MEDLINE | ID: covidwho-990692

ABSTRACT

BACKGROUND: We estimated population-level associations between ethnicity and coronavirus disease 2019 (COVID-19) mortality using a newly linked census-based data set and investigated how ethnicity-specific mortality risk evolved during the pandemic. METHODS: We conducted a retrospective cohort study of respondents to the 2011 Census of England and Wales in private households, linked to death registrations and adjusted for emigration (n = 47 872 412). The outcome of interest was death involving COVID-19 between 2 March 2020 and 15 May 2020. We estimated hazard ratios (HRs) for ethnic-minority groups compared with the White population, controlling for individual, household and area characteristics. HRs were estimated on the full outcome period and separately for pre- and post-lockdown periods. RESULTS: In age-adjusted models, people from all ethnic-minority groups were at elevated risk of COVID-19 mortality; the HRs for Black males and females were 3.13 (95% confidence interval: 2.93 to 3.34) and 2.40 (2.20 to 2.61), respectively. However, in fully adjusted models for females, the HRs were close to unity for all ethnic groups except Black [1.29 (1.18 to 1.42)]. For males, the mortality risk remained elevated for the Black [1.76 (1.63 to 1.90)], Bangladeshi/Pakistani [1.35 (1.21 to 1.49)] and Indian [1.30 (1.19 to 1.43)] groups. The HRs decreased after lockdown for all ethnic groups, particularly Black and Bangladeshi/Pakistani females. CONCLUSION: Differences in COVID-19 mortality between ethnic groups were largely attenuated by geographical and socio-demographic factors, though some residual differences remained. Lockdown was associated with reductions in excess mortality risk in ethnic-minority populations, which has implications for a second wave of infection.


Subject(s)
COVID-19/ethnology , COVID-19/mortality , Censuses , Death Certificates , Mortality/ethnology , SARS-CoV-2/isolation & purification , Social Determinants of Health , Adolescent , Adult , African Americans , Age Factors , COVID-19/diagnosis , Cohort Studies , England/epidemiology , Family Characteristics , Female , Humans , Male , Middle Aged , Pandemics , Residence Characteristics/classification , Residence Characteristics/statistics & numerical data , Retrospective Studies , Sex Factors , Socioeconomic Factors , Wales/epidemiology , Young Adult
18.
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
20.
Gac Sanit ; 35(6): 590-593, 2021.
Article in Spanish | MEDLINE | ID: covidwho-764627

ABSTRACT

The death counts from COVID-19 have generated public controversy. The regional health councils' need for information regardind the cases, has generated a variety of formats and procedures, used to report this information. Consecuently, this data has not always been communicated in a comparable maner to the Ministry of Health. The compilation of mortality statistics is complex. Central and autonomous public administrations are involved, and not in the same way. The medical death certificate (DC) is the main source of information that allows to specify place of occurrence and causes of death. The on-line registration of the DC in the computerized civil registry and/or digital medical records, would allow to establish a statistical processing circuit, and to obtain a death count more quickly according to causes of death in the event of a health emergency. This requires a multi-level institutional agreement for a total telematics statistic process of death causes in Spain.


Subject(s)
COVID-19 , Cause of Death , Death Certificates , Humans , Registries , SARS-CoV-2 , Spain
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