Are there more coronavirus victims than government statistics let on? A few days ago Gazeta Wyborcza reported on the cases of death under the home quarantine. The 45-year-old man from Głogów returned home from abroad with no signs of infection. He died before being tested for coronavirus. Sanepid refused to examine him post mortem.
Another case was a 50-year-old deceased woman from Konin, who returned from Germany. She informed her family that she was feeling unwell. Her body was found by the police. The officers requested Sanepid inspectors to conduct post-mortem tests but Sanepid refused. Such cases are not included in the official government statistics of coronavirus victims.
Sanepid accuses journalists of "chasing a cheap sensation"
In such situations - when a person dies at home, with symptoms of infection - should sanepid conduct post-mortem tests?
"A person in quarantine is a person without signs of infection" told us Jan Bondar, spokesman for the Chief Sanitary Inspector. The basis on which Mr Bondar formulated such a conclusion remains unknown. There is no medical evidence to support the claim that a person on quarantine will not get ill.
"In every case the cause of death is determined by the doctor" Bondar adds, "it has been like that for decades and every reliable journalist should be aware of this. I personally consider discussing who in Poland or in the world may have died from being infected with coronavirus or any other virus as chasing cheap sensation, not as reliable journalism."
When a patient dies at home, he or she is usually diagnosed by a family doctor (in Poland, the coroner's institution is practically non-existent).
The special instruction on how to act in this kind of situation has been prepared by the Association of the Family Doctors. The doctors are advised to call the family and ask them if the deceased was infected or if there is ground for such suspicions (e.g. he returned from abroad). If the answer is yes, the doctor shall notify the sanitary department. - Sanepid should ask the starosta (representative of the local government) to appoint a special coroner (a doctor responsible for declaring deaths) - says Michał Sutkowski, spokesman for the association. - Family doctors do not have necessary protective equipment to do that. We lack overalls, masks, goggles. Sanepid did not provide us with this.
What should the doctors do?
In the case of deaths in Konin and Głogów, there were policemen and rescuers with appropriate equipment. However, another problem arose: how to determine whether the deceased were infected and whether the cause of death was indeed Covid-19.
As one of the forensic doctors explains, the autopsy is not an option in this case, since it would have to be ordered by a prosecutor: - There has to be suspicion of crime to conduct the autopsy, and these deaths were due to natural causes. The prosecutor's office is not interested in epidemiological investigations. Also, no forensic institution is prepared for the autopsy of a person infected with coronavirus.
The easiest method would be for the sanepid to take a sample from the upper respiratory tract and examine it in the laboratory. Sanepid, however, refuses to do that. Family doctors tell us: - Even if we are almost sure, we will not write in the death card that the cause of death was COVID-19. We do not have the means to prove it.
- It is easier for a doctor to rule out COVID-19 as a cause of death than to confirm it. But if the doctor has such suspicions, he should note this in the documents. We cannot agree to medical censorship out of fear of officials - emphasizes Dr. Sutkowski.
Family doctors: Knowledge about infection is essential
- The ambulance crew resuscitated an elderly woman with pneumonia who was on antibiotics. The resuscitation failed. An ambulance doctor suspected coronavirus. We quickly established that the elderly lady did not leave the house and had no one to infect her. But I don't know what I would do if it was a person under home quarantine - tell us the head of one of the poviat sanitary stations in western Poland.
Poviat inspectors are in a difficult situation, because in mid-March the supervision over them was taken over by voivodes, who represent the central government. If someone decides to go against the central authorities, he can quickly lose his position. The first resignations are already there: on Friday, the head of the sanitary department in Krotoszyn was dismissed. A spokesman for the Wielkopolska voivode refused to give reasons for resignation.
The Polish doctors we talked to are convinced that the sanitary department does not want to do post mortem tests, so as not to increase the death toll statistics. Michał Sutkowski from the College of Family Physicians does not understand this attitude: - After all, the goal is not statistics, but to stop a pandemic. If we do not know if the deceased was infected, then we do not know whether it is necessary to quarantine the people with whom he had contact before death. From this point of view, knowledge about infection is crucial. I am surprised that sanepid does not understand this.
Coronavirus. Are other countries doing post mortem tests?
Different countries in Europe adopt different tactics. Italians carry out post mortem tests, despite the fact that it raises the high number of epidemic victims in this country. The premise for taking samples from the deceased is the occurrence of COVID-19 symptoms before death. Every deceased with a positive result is treated as an epidemic victim. In turn, in Spain, thanks to a post-mortem test, it was found that the first victim of the epidemic in this country was a resident of Valencia.
On the other hand, Germany assumes a similar assumption as Polish sanepid: they examine samples taken from potential infected during their lifetime, not after death.
In the UK, post mortem tests are only performed when the patient has died in hospital. One of the British forensic doctors argued in the media that suspicious deaths outside hospitals must also be investigated, because sweeping them under the rug will not do any good: - We need to know why people are dying. If you don't do tests, you won't know.
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