COVID-19 and the selection problem in national cause-of-death statistics

Area of Science:

• Public Health
• Epidemiology
• Medical Coding

Background:

• The World Health Organization (WHO) provides guidelines for classifying deaths due to coronavirus disease (COVID-19).
• Accurate cause-of-death classification is crucial for public health surveillance and prevention strategies.
• Current WHO guidelines emphasize selecting COVID-19 as the underlying cause of death, independent of comorbidities.

Purpose of the Study:

• To analyze the effectiveness of current WHO coding rules for COVID-19 deaths from a public health prevention perspective.
• To explore potential improvements in cause-of-death classification for enhanced disease prevention.

Main Methods:

• The study critically examines two specific WHO coding rules for COVID-19 deaths.
• It analyzes the implications of these rules for selecting the underlying cause of death.
• It considers the future potential of zoonotic classification for SARS-CoV-2.

Main Results:

• The article argues that the current WHO rule of counting COVID-19 deaths independently of pre-existing conditions may not always be optimal for prevention.
• It suggests that classifying COVID-19 deaths based on their zoonotic origin could offer greater preventive value.
• The identification of the animal source of SARS-CoV-2 could enable a more effective zoonotic classification code.

Conclusions:

• Current WHO coding practices for COVID-19 deaths may limit optimal public health prevention.
• Future identification of SARS-CoV-2's animal origin could facilitate a new zoonotic classification code.
• A zoonotic classification could enhance preventive strategies by targeting the source of the virus.