True death toll of COVID-19 in Georgia: estimates of the number of deaths from COVID-19

Abstract

Abstract Problem Georgia, in terms of Covid-19 attributed mortality, ranks 8th in the World. Description In Georgia, there are no routinely conducted autopsies of the deceased. The identification of causes of death is based on the physician’s clinical decision. Absence of autopsies, lack of experience with Covid-19, are key issues of Covid-19 death certification. Considering COVID-19 as a primary cause of death led to over-reporting of COVID mortality among patients with severe comorbidities. This affects the identification of underlying cause of death (UCOD) and leads to misclassifications. Results 2021 mortal cases with Covid-19 as the UCOD, were analyzed. Cases were grouped by the interval between testing and death: <1 day - 170 cases (1.5%), 2-44 days - 9468 cases (83.5%), 45+ days - 1694 cases (15%). The group of cases with time intervals of 2-44 days, was sub-grouped according to causes mentioned in death certificates: A - only U07 is indicated, B - U07&any chain-of-event condition (pneumonia, respiratory distress, respiratory failure, etc.), C - U07& 1 or more significant contributing conditions (diabetes, stroke, etc.). According to the analysis in the group, 2-44 days distribution was: A - 6%; B - 81%; C - 13%. U07 cases in groups A and C without any respiratory conditions mentioned were defined as ‘unlikely’ COVID-19 death (19% of total). From groups with time intervals of < 1 and 45+ days (1864) 72 cases were randomly selected for in-depth analysis by a panel of experts, using additional medical records. Out of these cases, the panel of experts considered 80%, as ‘non-COVID-19’ deaths. Lessons If ‘unlikely’ and ‘non-COVID-19’ deaths aren't counted, the number of deaths is reduced by 29.5%. Lack of duration of a disease represents a limitation. A similar revision of all/2-44 day’s interval COVID-19-related deaths is required to get a real number. Conduction of a verbal autopsy is necessary. Training on coding causes of death and existing regulations is important. Key messages • There is an over-registration of COVID-19 as a UCOD. • The lack of knowledge of death certification of cases with severe comorbidities and accidents leads to over estimates.