Concerns have been raised over how South Africa is counting the number of people who have died in South Africa due to COVID-19.
This follows reports of several children and teenagers who tested positive for the coronavirus, but whose deaths were not necessarily caused by COVID-19.
One of the cases was a two-day-old baby, who was born prematurely to a mother who tested positive for the coronavirus.
While the fact that the mother probably transmitted the virus to her unborn child is scientifically significant, the baby did not die because of COVID-19.
Shabir Madhi, a professor of vaccinology at the University of the Witwatersrand, told eNCA that the cause of death was hyaline membrane disease and the fact that the child tested positive for the coronavirus that causes COVID-19 was purely coincidental.
Several other cases have also been questioned. These include a two-year-old baby with serious comorbidities, a teenager who was suffering from a very rare disease, and a teenager who died in a car accident.
Madhi explained that there is a standardised way in which cause of death forms must be completed. There appears to be a deficiency in training that has resulted in the forms of at least two of aforementioned deaths being completed incorrectly: that of the premature baby, and of the car crash victim.
“The absolute manner in which to make a definite diagnosis as to whether a case is due to COVID or not is to do post-mortem biopsies, or a post-mortem,” Madhi stated.
“Unfortunately that is not really done in South Africa. Often we need to use our clinical judgement in terms of whether there is a biological association between the clinical illness that the person dies from and the presence of the virus.”
Madhi explained that there are clear guidelines from the World Health Organisation and standardised criteria in South Africa for how to attribute cause of death.
COVID-19 deaths in South Africa should be revised downwards
He also agreed that South Africa’s official COVID-19 death toll should be revised downwards, but added that we should avoid becoming fixated on the exact number as it is already a conservative estimate.
Further questioned on the importance of the accuracy of the daily statistics coming from the government, specifically as it relates to children under 18 whose parents must make a decision on whether it is safe for their child to return to school, Madhi agreed that there is an issue.
“It is very misleading to indicate that five children have died from COVID-19, when it’s really only two. And even those two cases were children with comorbidities,” said Madhi.
“They had risk factors as to why they developed severe disease, which is not what occurs in the average child under the age of 18. [Children] would really rarely develop severe disease, let alone die.”
Madhi stated that there is an urgent need for adequate training of healthcare personnel in terms of how to complete the cause of death field on death certificates.
He said that there are clear guidelines, and these examples are exactly what should be avoided when completing filling in the cause of death.
Ideally, what should happen is that a group of doctors arbitrate the cause of all of these deaths, especially the unusual ones, Madhi said.
He explained that there are guidelines for attributing cause of death that were developed by the South African Medical Research Council.
“Those are available in the public domain and I would strongly urge healthcare workers to access that from the Medical Research Council website, which gives clear guidelines in terms of how COVID deaths should be attributed.”