❦ “Covid deaths get minimised with “but they were probably dying with something else anyway”.

I work in End-of-Life Care. Let me explain how we all die and why this minimising approach to Covid-associated deaths makes no sense, although it may be a mass-protective mechanism globally.

Dying ‘with’ Covid is commonly used to minimise and/or possibly mitigate the catastrophic and distressing reality of numbers who have died ‘of’ Covid: currently more than 6.9 million worldwide.

Likely an underestimate, as these are reported cases only.

>6.9 million, RIP. 

Premature deaths resulting from Covid are certified as such. Doctors do not put items on death certificates unless they are (1) the immediate cause of death, or (2) contributed to the death. So if Covid is listed, it is part of the reason the person died.

It is common to die ‘with’ something such as pneumonia (on top of cancer or heart failure or renal failure for example). Both would appear on the death certificate, but it is often the acute illness (the pneumonia in this case) that is the precipitating factor towards death.

Without the acute event, we may live on for months or years depending on the underlying serious illness.

In a similar way, Covid impacts primarily on those more vulnerable. It comes along and sadly takes off months or years of someone’s life for those who get very sick and die.

In over 20 years in healthcare and being around the dying, I have never witnessed a death being minimised with “They were dying with something else anyway” prior to Covid.

People died after pneumonia, bringing cancer / kidney / lung / heart failure journeys to an end – but never mimimised.

Professionals, families or the public never said, “Oh sure, but they were dying for some time of cancer anyway,” as if this acute event that precipitated these deaths was less culpable, less meaningful, minimised to a trivial occurrence that was probably unrelated.

The trouble is, these acute events are entirely related.

They are the events that put a final stop to a host of progressive illnesses that most of us will die from.

They are a common ultimate mechanism for untimely deaths for those with chronic illness too.

So dying ‘with’ or ‘of’ Covid is meaningless, even if you wish to use this dubious distinction. Ultimately it serves as the acute event that leads to death for those vulnerable to it.

>6.9 million and counting.

To put it another way – Covid is the bus that crashes into you as you cross the road.

Sure, you had cancer / diabetes / heart, kidney, lung or neurological disease to begin with, so let’s ignore the bus – you were probably dying with “something else anyway”.

Except the bus mattered.

The bus precipitated your decline and your untimely death. Without the bus you’d still be here. The bus mattered. Covid matters. Let’s not minimise deaths related to it anymore, whether it’s a primary or a contributing cause.

It may help us cope as a collective psychological trauma response to the pandemic (minimising)... But it belittles the deaths of millions and does nothing to help their grieving families.

Minimising the causes of death has no place in healthy grieving.

The pandemic is awful. Untimely death is awful. Covid is awful. Deaths directly due to Covid and deaths precipitated by Covid are all awful.

Why are we not all on the same page with this?

The knee-jerk comment of “they were probably dying of other things” needs to end.

Enough now.”

❂

© 2023 NHS Palliative Care Medicine Consultant.