Throughout the history of COVID-19, one of the most important bits of data is how many deaths there have been. If COVID was like influenza in terms of mortality, we would not be discussing it like we are today.
In Albania, the number of deaths has increased with a sharp rise in numbers in the last two months. Yesterday, there were 19 deaths- a record number since the pandemic began. This fact has also been the main defence of the government who has been accused of mismanagement and under-reporting the number of deaths. It has also used these ‘low’ figures to justify its decision not to conduct widespread testing, or even increase the level of testing.
So what if the number of deaths is actually higher?
The opposition has started alleging that the government, not doctors, are hiding the real number of deaths from COVID-19. They have asked SPAK and the prosecutor to investigate. The government denies the claims and has counter-attacked the opposition, saying they are attacking doctors. No real evidence has been presented from either side.
The number of deaths cannot really be hidden. When a person dies in hospital, it is recorded on a death certificate, a hospital card, in the morgue, in the civil registry, and the cemetery services.
When someone dies in hospital, the doctor who treated them is legally liable to complete the death certificate which contains information such as who they were, what they died from, when they died, and where.
From the hospital, the body including the death certificate goes to the morgue. The body and the file are then passed to the family. The family then deregister the individual in the civil registry and obtain a burial permit. Statistics are reported to the Ministry of Health and INSTAT.
Hiding the number of those who have died would be difficult as it would require fraud in a number of institutions and from many different stakeholders.
But, there is one thing that is much easier: hiding the cause of death. The cause of death is the chain of events that led to the death including conditions and diseases.
- First, there is the underlying or primary cause which is the disease or injury that starts the chain of events leading to the ultimate cause of death.
- Second, there is the ultimate cause of death which is the illness or final condition that lead to death. This can change radically.
When the doctors fill out the card, they can writer either COVID-19 or another condition. There are a number of problems when identifying a COVID death such as whether the patient had COVID and died, or whether they died from COVID.
We do not know whether the government are reporting just those who died from COVID or those that had COVID and died from something else.
The World Health Organisation has made it clear that COVID should always be noted when there is a positive result when it’s suspected when they have recovered from it but have died of an undetermined cause.
Different countries have taken different approaches and these have changed as a result of the number of deaths. In Albania, the question remains as to whether the government is only counting deaths from COVID, or whether they are counting suspected cases, negative tests but showing other symptoms, or complications from, as well.