Publication date: Jun 22, 2023
Death within a specified time window following a positive SARS-CoV-2 test is used by some agencies for attributing death to COVID-19. With omicron variants, widespread immunity, and asymptomatic screening, there is cause to re-evaluate COVID-19 death attribution methods and develop tools to improve case ascertainment. All patients who died following microbiologically-confirmed SARS-CoV-2 in the Veterans Health Administration (VA) and at Tufts Medical Center (TMC) were identified. Records of selected vaccinated VA patients with positive tests in 2022, and of all TMC patients with positive tests in 2021-22, were manually reviewed to classify deaths as COVID-19-related (either directly caused by or contributed to), focused on deaths within 30 days. Logistic regression was used to develop and validate a surveillance model for identifying deaths in which COVID-19 was causal or contributory. Among vaccinated VA patients who died within 30 days after a positive test in January-February, 2022, death was COVID-19-related in 103/150 (69%) of cases (55% causal, 14% contributory). In June-August, 2022, death was COVID-19-related in 70/150 (47%) of cases (22% causal, 25% contributory). Similar results were seen among the 71 patients who died at TMC. A model including hypoxemia, remdesivir, and anti-inflammatory drugs had PPV 0. 82-0. 95 and NPV 0. 64-0. 83. By mid-2022, “death within 30 days” did not provide an accurate estimate of COVID-19-related death in two US healthcare systems with routine admission screening. Hypoxemia and use of antiviral and anti-inflammatory drugs – variables feasible for reporting to public health agencies – would improve classification of death as COVID-19-related.
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