CDC: ‘COVID-19 exposure’ should be left off of death certificates

But a Grand Strand woman says that’s what was listed on her mother’s amended death certificate
Updated: Sep. 15, 2020 at 11:23 PM EDT
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HORRY COUNTY, SC (WMBF) - WMBF Investigates is continuing to look into a local death certificate originally mislabeled with COVID-19, to find more on what kind of oversight exists.

Georgetown County native Brenda Presley said her mother, Mary Miller, was tested three times before she died, testing negative for the virus each time.

Miller’s doctor, who wrote COVID-19 as the cause of death apologized, saying it was a mistake and that it would be amended.

But Presley said the system now shows that “COVID-19 exposure” was as a significant condition contributing to her mother’s death.

RELATED COVERAGE | Grand Strand family frustrated after mother’s death certificate amended to say 'COVID-19 exposure’

Presley said the Department of Health and Environmental Control’s Web Death system, which tracks South Carolinian death certificates, shows in Part I that her mother died solely from “Acute Respiratory Failure", and that in Part II, “COVID-19 exposure”, dementia, and CVA were significant conditions contributing to her death.

WMBF Investigates reached out to the CDC, which establishes guidance on how to report COVID-19 deaths.

The CDC’s National Center for Health Statistics reported that a death certificate with only one immediate cause of death in Part I is bad practice.

“In this case, it seems the certifier left off some important information," said Bob Anderson, the chief of the Mortality Statistics branch for the CDC’s National Center for Health Statistics. “We want that underlying cause because we want to know what started the chain of events leading to death. That’s what we need to know for prevention purposes.”

Anderson said Part I of a death certificate asks for a causal pathway - a sequence of events to show why the immediate cause of death happened because of an underlying cause.

In addition, listing COVID-19 exposure on the certificate is not recommended. According to the Coronavirus Disease FAQs listed on the CDC’s website, “Certifiers should not report ‘exposure to COVID-19’ or ‘possible exposure to COVID-19’ on death certificates."

The guidance continues on to say, “A person may be exposed to the virus, but that does not mean the patient contracted or became infected with the virus, developed the disease (exhibited its signs or symptoms), or that it caused or contributed to the death.”

“Simple 'exposure to COVID-19′ is not a cause of death. It’s not a contributory factor," Anderson explained. "The person would have had to have had COVID-19 for it to be, in my view, for it to be eligible to be put on a death certificate.”

Although this case found in the Grand Strand doesn’t seem to match up with the federal agency’s guidelines, they don’t have the power to enforce it.

“We don’t have any legal recourse. We can provide guidance, but we can’t enforce that guidance,” Anderson said. “We can’t even make it mandatory; we can only advise.”

“It’s, I think, inherently unsatisfying," Anderson said, “because we end up with errors that we shouldn’t have. At the same time, do we want the federal government looking over the shoulder of every certifier in the country? I’m not sure we do. And I’m not sure that even if we did want that, that we could do it. Given that there are thousands - tens of thousands of certifiers.”

Anderson said, however, the word “exposure” is rarely found on a death certificate and something they don’t see very often. From a statistical standpoint, he doesn’t see such an incident as playing a significant factor in skewing the COVID-19 death count.

In an email sent Tuesday, DHEC told WMBF Investigates that DHEC’s role does not include approving or rejecting the causes of death.

“The agency’s role is to be the official state record-keeper of vital records like death certificates and the data derived from them that are submitted to us by trained medical certifiers,” DHEC told WMBF Investigates.

DHEC also explained that death certificates submitted to their agency “are sent to the CDC where nosologists code the certificate as one cause of death for the whole record and send that code back to us for record-keeping. We then report the number of deaths with that CDC code."

DHEC said medical certifiers determine the cause of death.

In an updated statement from Tidelands Health Tuesday, they said in part, "a physician completing a death certificate assesses an individual’s health records and conditions to determine a cause of death and includes contributing factors that could have led to the primary, secondary or tertiary cause of death. Tidelands Health is prohibited by law from interfering with the independent medical judgment of a physician.”

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