Health Secretary Łukasz Szumowski told TVN24 on Monday, “The public is informed about every deceased person. Sometimes we add the cause of death was probably different but we do not withhold information, nor do we attempt to list patients as [dying as the result of] different diseases. Our opinion is that we need to be absolutely transparent here.”
Gazeta Wyborcza has information regarding at least four patients who died from the coronavirus but were not recorded among the government’s list of fatalities. On Tuesday evening, the deaths of 33 people were listed.
A 75-year-old man died on March 23 at a hospital in Kalisz, Greater Poland. He developed a cough and breathing difficulties while recovering from a scheduled procedure. A CT scan confirmed massive pneumonia in both lungs, a major symptom of the Covid-19 disease. A sample taken after his death confirmed the infection. Doctors listed heart failure as the cause of death, despite the results of the test.
A 79-year-old man who had been diagnosed positive for the coronavirus died on March 24 at a hospital in Radom, Masovian Voivodeship. The hospital did not disclose what the doctors believe to be his cause of death. The hospital unit limited itself to a laconic statement which mentioned, ‘underlying health conditions.’
An 85-year-old male with a confirmed coronavirus infection died on March 26 at a hospital in Kalisz. He displayed symptoms of Covid-19 but doctors stated his death was the result of heart failure.
A 66-year-old man died on March 27 at a hospital in Wrocław. Lung cancer was listed as the cause of death, despite his testing positive for the virus.
“He would have probably died because of cancer but the infection with coronavirus hastened his death. In my opinion, it was the viral infection that should be listed as an immediate cause of death”, an epidemiologist at the Medical University of Poznan told Wyborcza.
Some doctors have explained an underlying condition may affect how a patient reacts after becoming infected with the coronavirus, but it is the latter which causes death.
Hospitals send data concerning fatalities among infected patients to local Public Health (Sanepid) units, which are supervised by representatives from the provincial governors (voivode). Units then forward information to the central authority in Warsaw.
“We are guided by what is listed by doctors on death certificates. We are public servants and we do not interfere with doctors’ expertise,” a spokesperson from the Greater Poland Voivode told Wyborcza.
Three patients have died at Poznan’s isolation hospital. Doctors have no doubt the coronavirus caused their deaths and that their underlying conditions were of no importance.
“Patients who test positive [for the virus] and [whose] deaths are in line with Covid-19 symptoms are listed with Covid-19 as the cause of death. We don’t need any special guidance to do that, it is basic knowledge,” consultant Jacek Gorny said.
But a death certificate form does allow for some manipulation. Not one, but three causes of death are required. They are ‘immediate, ‘subsequent’ and ‘initial.’
Immediate: respiratory failure
When an 85-year-old died in Kalisz, Greater Poland, a voivode spokesperson argued, “The infection was not the immediate cause of death.”
“Of course, the immediate cause of death is the result of an illness,” a doctor said, giving an opinion on the statement. “The infection itself will never be an immediate cause of death.”
The National Institute for Public Health (PZH) has recognised the problem and has issued an instruction for medics, recommending they “treat contagious disease as a cause of death paramount to non-contagious ones.”
The PZH supports its statement with recommendations from the World Health Organisation (WHO), but in a selective fashion. The PZH instruction does not take into account that the WHO accepts deaths may be listed as caused by the coronavirus, even when a test has not been conducted. According to the WHO, symptoms typical of Covid-19 - such as pneumonia - are sufficient, due to the large number of patients who have not been tested (such as the case of the 75-year-old in Kalisz) or when the result is unclear (for example, if a sample was collected too soon).
It is unclear why doctors have omitted the mention of Covid-19 as a cause of death when patients have tested positive for the virus. The WHO has long considered Polish statistics to be untrustworthy. Several years ago, the Polish Central Office for Statistics (GUS) warned that doctors fail to correctly identify a cause of death because they seem to prefer certain causes, while some others are underrepresented.
“For years now, medical practitioners in Poland have failed to fill the death certificate forms correctly,” said Krzysztof Kordel, a forensics doctor and a former head of the Doctors Chamber of Greater Poland. “It results in the WHO’s lack of recognition for Poland’s epidemiological reports. However, the reasons here are a lack of experience and knowledge. It is not a form of political precaution.”
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