Validation of verbal autopsy and nasopharyngeal swab collection for the investigation of deaths at home during the COVID-19 pandemics in Brazil

Souza, Pedro Mansueto Melo de; Gerson, Gunter; Dias, Josebson Silva; Melo, Deborah Nunes de; Souza, Sarlene Gomes de; Ruiz, Erasmo Miessa; Távora, Fábio; Cavalcanti, Luciano Pamplona de Góes

doi:10.1371/journal.pntd.0008830

Cited by 11 publications

(9 citation statements)

References 9 publications

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“…The specific modification we employed has not yet been validated – although other modifications to the WHO VA instrument to address COVID have been 24,25 . Nevertheless, assessments of VA modifications to capture SARS-CoV-2 show there is error and diagnosis should be complemented with minimally invasive techniques such as ultrasound when the decedent’s cadaver is available 26 .…”

Section: Discussionmentioning

confidence: 99%

The Mortality Burden from COVID in Low-Income Settings: Evidence from Verbal Autopsies in India

Malani,

Zhao

2024

Preprint

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Measuring the mortality burden of SARS-CoV-2 in lower-income countries is difficult because death registries are incomplete and lack cause of death. We address this problem in India, which had the second-highest number of officially reported cases. We completed WHO-compliant verbal autopsy (VA) surveys on roughly 20,000 deaths drawn from a population-representative sample. SARS-CoV-2 deaths spike in June 2020, just after India’s lockdown, and in May 2021, after its second wave. During those spikes the virus is responsible for 23.3% and 35.8% of all deaths, respectively. Cardiovascular deaths also spike during the start of the pandemic. We find that the death rate rises by 81% during the pandemic, SARS-CoV-2 is responsible for 33% of these excess deaths, and cardiovascular disease for 23% of these deaths.

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Section: Discussionmentioning

confidence: 99%

The Mortality Burden from COVID in Low-Income Settings: Evidence from Verbal Autopsies in India

Malani,

Zhao

2024

Preprint

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“…The period corresponds to the first phase of the pandemic in the state of Ceara—which peaked in the 19th epidemiological week (from May 3 to 9) and started to decrease from the 20th epidemiological week (from May 10 to 16)—and was chosen for being the most critical period for the health systems when the characteristically exponential growth was presented. 6 …”

Section: Methodsmentioning

confidence: 99%

COVID-19 Home Deaths without Medical Assistance in Northeastern Brazil

Souza¹,

Gerson

Soares

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Since its beginning in Wuhan, China, in December 2019, the disease caused by COVID-19 has reached more than 27 million confirmed cases and more than 880 thousand deaths worldwide by early September 2020. Although it is known that some of these deaths may have been influenced by the overload of health systems, the world medical literature lacks data on deaths due to COVID-19 in patients who have not received medical assistance. We conducted a retrospective transversal study to report the clinical and epidemiological profile of the first 200 consecutive cases of home deaths without medical assistance caused by COVID-19 diagnosed by verbal autopsy and real-time PCR in samples of postmortem nasopharyngeal swabs, in the state of Ceara, in Northeastern Brazil. The data show a slightly increased prevalence of cases in males (57%) and an average age of 76.8 years. Previous comorbidities were reported in 85.5% of cases, the most common being cardiovascular disease (45%), neurological disease (30%), and diabetes (29%). The main symptoms reported were dyspnea (79%), fever (75.5%), cough (69%), and fatigue (42.5%). The average time between the onset of illness and death was 7.3 days, being statistically shorter in patients who had previous comorbidities (P = 0.0215). This is the first study to evidence the clinical and epidemiological characteristics of COVID-19 home deaths without medical assistance, which may represent a considerable portion of the pandemic burden, especially in the context of health system overload.

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“…A verbal autopsy has also been employed in the COVID-19-related pandemic context achieving good results [ 15 ]. Given the need to perform the anamnestic interview with relatives more methodical before performing an autopsy, and also considering scenarios of undoubted severity (e.g., the pandemic) where autopsies fail to be routinely performed, one possible solution is to import the methodology of verbal autopsy to supplement the autopsy assessment.…”

Section: Introductionmentioning

confidence: 99%

Verbal Autopsy as a Tool for Defining Causes of Death in Specific Healthcare Contexts: Study of Applicability through a Traditional Literature Review

Bailo

Gibelli

Ricci

et al. 2022

IJERPH

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Autopsy examination, the gold standard for defining causes of death, is often difficult to apply in certain health care settings, especially in developing countries. The COVID-19 pandemic and its associated difficulties in terms of implementing autopsy examinations have made the need for alternative means of determining causes of death even more evident. One of the most interesting alternatives to the conventional autopsy is the verbal autopsy, a tool that originated in Africa and Asia in the 1950s and consists of a structured interview with the deceased’s family members concerning the symptoms manifested by the person and the circumstances of death. In the early 1990s, the first doubts emerged about the validity of verbal autopsies, especially about the real reliability of the cause of death identified through this tool. The objective of the review was to identify studies that had assayed the validity of verbal autopsies through a rigorous comparison of the results that emerged from it with the results of conventional autopsies. When starting from an initial pool of 256 articles, only 2 articles were selected for final review. These are the only two original research articles in which a verbal autopsy validation process was performed by employing the full diagnostic autopsy as the gold standard. The two papers reached opposite conclusions, one suggesting adequate validity of verbal autopsy in defining the cause of death and the other casting serious doubts on the real applicability of this tool. Verbal autopsy undoubtedly has extraordinary potential, especially in the area of health and demographic surveillance, even considering the implementation that could result from the use of artificial intelligence and deep learning. However, at present, there appears to be a lack of solid data to support the robust reliability of this tool in defining causes of death.

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Validation of verbal autopsy and nasopharyngeal swab collection for the investigation of deaths at home during the COVID-19 pandemics in Brazil

Cited by 11 publications

References 9 publications

The Mortality Burden from COVID in Low-Income Settings: Evidence from Verbal Autopsies in India

The Mortality Burden from COVID in Low-Income Settings: Evidence from Verbal Autopsies in India

COVID-19 Home Deaths without Medical Assistance in Northeastern Brazil

Verbal Autopsy as a Tool for Defining Causes of Death in Specific Healthcare Contexts: Study of Applicability through a Traditional Literature Review

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