The Classification of COVID-19 as a Contributing Factor

Marvin Manzanero

And also in COVID-19 related news, Dr. Marvin Manzanero explains the classification of COVID-19 related deaths. He says that while persons may have COVID-19 and other conditions, their death certificate will list COVID-19 as a cause because the virus creates complications for some of the persons who have pre-existing conditions, such as Carlos Peralta from Orange Walk who died over the weekend.

Dr. Marvin Manzanero, Director of Health Services

“In terms of classification of deaths, I know that there as a concern particularly with the two patients that died over the weekend as to whether they should be classified or not. We went back to review what international guidelines say. I should have brought a copy of a death certificate – it outlines what the persons die of. It gives you one, two, three, four and underneath there is a section that says conditions that may be a contributing factor. I will use an example of a myocardial infarction – somebody who dies of a heart attack and who has high blood pressure, for example, that might be the secondary cause of death. But underneath if you are also diabetic and have high cholesterol, those are contributing factors that you can put and those are attributed to myocardial infarction. So, it is a similar situation. We consulted with regional public health agencies. While COVID-19 may not be the immediate cause of death it may be a contributing factor in people who have myocardial infarction and other situations. I am bringing this to the people’s attention because when you review the literature, you find out that COVID-19 doesn’t only do respiratory failure but people who have COVID-19 have also been documented to have what is called a prothrombotic process which means your system of body is more easily or likely to develop clots so that can contribute to heart attacks; strokes; clots in the lungs; pulmonary embolism. Interestingly enough, the patient who died on Saturday, it is associated to a heart condition and we may not know how much of that a contributing factor with COVID-19 was because he had other conditions. But we have another patient who has a stroke at K.H.M.H.; not intubated; hospitalized who is also COVID-19 positive; the diagnosis was mad after the stroke had been documented. We have another patient that was intubated yesterday; she had already been diagnosed with COVID-19 and arrived in respiratory distress rather promptly so it could be that there is a prothrombotic process happening in the lungs for her. So, I think that is important to say.”