Died with or from? The COVID death toll is more complicated than it appears

To die with or to die from? That is the question. Australia’s federal tally clocks our COVID-19 death toll at 810 (seven deaths listed in Victoria this morning are yet to be included).

But recent questions around whether a person died from COVID-19 or with it has made many wonder just how accurate this tally is.

Just 9% of Australians who died from the virus had no co-morbidities.

How deaths get added to the tally

Epidemiologist and senior lecturer at the University of Melbourne Dr Alex Polyakov told Crikey that in Australia a death is attributed to COVID-19 if the person tested positive and there was no other reason for them to have died. 

When filling out death certificates, doctors have to determine the main cause of death, followed by additional causes. Only those whose main cause of death was listed as COVID-19 were counted in the federal tally, he said.

“Everyone has to die of something,” he says. “Someone in their 90s who has a good death, they go to sleep and just don’t wake up. That could be attributed to a heart attack or a stroke.

“If they tested positive the day before they went to sleep, they would be classified as a COVID-19 death — even though [it’s] likely it’s just because their time has come.” 

The classification is much easier in younger, healthier people. One man in his 20s was reported to have died with COVID-19 and a coroner investigated. His death was initially reported in Victoria’s daily death toll but wasn’t added to the federal death tally. 

This, Polyakov said, was probably because he died of another clear reason unrelated to COVID-19: “Testing positive for the virus may have been incidental”.

How solid are the numbers?

In the early days of the pandemic, COVID-19 may have been deadlier than initially reported. Australia had more than 800 “excess deaths” in the first quarter of 2020 compared with the previous five-year average, although just 103 deaths were classified due to COVID-19.

But Polyakov said the data was solid now. “The deaths are a terrible tragedy for families, but they also show how well Australia’s response has been compared to the rest of the world,” he says.

The tally may fluctuate slightly when cases are reexamined.

While it’s a tragic toll, Australia’s death rate is much, much lower than most countries. The death rate in those infected with the virus has increased over the past month from 1.3% to 2.3%, partly due to delayed reporting in aged care home deaths. 

Around the world, about 3.4% of those who tested positive for the virus have died. Mexico has the highest case-fatality ratio at 10.6%. The US has the highest death toll: more than 194,000 deaths and 6.5 million confirmed cases. Its case fatality rate is 3%.