Characteristics of deceased and quality of death certificates for cases subjected to Indonesia’s management of the dead protocol for bodies with COVID-19

Abstract

The COVID-19 pandemic has significantly impacted many aspects of life, including death care. International and national protocols have been implemented for the management of the dead. This study aims to determine the characteristics of decedents managed according to COVID-19 protocols in Indonesia and the quality of their death certificates. This study uses a descriptive, cross-sectional design. Secondary data of deaths with COVID-19 were taken from hospital death registries, medical records, and death certificates. Data were collected from nine referral hospitals and one funeral home in 6 cities in Indonesia. The majority of the decedents were male, Muslim, with a median age of 57. Most were treated in non-intensive isolation wards, and almost half had known comorbidities. Many were still awaiting the result of their confirmative PCR at the time of death. Almost all were managed compliant with the standard protocol, and most were buried in COVID-only cemeteries. There were still deficiencies in the completeness and accuracy of the death certificates. "COVID-19" was mentioned as a cause of death in only about half of the cases, with a wide variety of terms and spelling. Management of the dead protocols for bodies with COVID-19 can generally be implemented in Indonesia. The quality of the death certificates should, however, be continuously improved. Keywords COVID-19 death • Management of dead bodies • Death certification • Multiple causes of death

Risk factors for deaths associated with COVID-19 according to the cause of death classification in Republic of Korea

“…In general, it is difficult to obtain characteristics of infected patients and clinical observations of patients at the population level in the early stages of a pandemic [ 34 ]. Thus, determining the exact cause of death is essential for planning prevention and control measures, especially during a pandemic that requires rapid public action [ 24 ]. In addition, high-quality death certificates containing correct information enable national health authorities to collect timely and accurate information to assist in the assessment and management of infectious diseases [ 20 ].…”

“…In Brazil, it was difficult to accurately determine the number of deaths associated with COVID-19 due to the limited availability of diagnostic tests in the early stages of the pandemic [ 21 , 22 ]. In addition, issues related to the classification of deaths have been raised, as India lacks complete death certificates [ 23 ], and Indonesia is known to have under-reported deaths due to incomplete certification of deaths [ 24 ]. A study also identified many errors related to causes of death on death certificates in Iran [ 25 ].…”

Death certification errors in medical certificates of cause of death related to COVID-19 disease

“…This distribution is consistent with other studies which revealed that advanced age is a significant risk factor for death and is true for novel coronavirus disease. [22][23][24] 25 -Grade V error (underlying cause of death was incorrectly attributed or placed in an improper sequence, n=176, 87%)…”

“…31 A similar finding was noted in the Indonesian study on the quality of COVID-19 death certificates. 22 In the present study wrong terminology like "COVID", "COVID pneumonia", "COVID +ve", and "coronavirus" were used instead of COVID-19 and novel coronavirus disease. It has been made clear by COVID-19 guidelines for death certification and coding that only COVID-19 is an official terminology to be used for all certification of this cause of death.…”

“…Meilial et al reported that in most COVID-19 death certificates, the time interval was not filled. 22 Not mentioning the time interval is a common error made by certifying physicians and has been reported in a frequency ranging from 69.2% to almost 98.9% of cases in death certificates issued in non-COVID-19 deaths. 19,20,25,29 Illegible handwriting, classified as a minor error, was found in 26.47% of death certificates, however, Burger et al reported it in 2.5% of cases.…”