ChesterCountyMedicineSpring2020 - 21

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Death Certificates
in the Time of COVID-19
BY CHRISTINA VANDEPOL, M.D., CHESTER COUNTY CORONER

W

ho would have thought death
certificates (DCs) would ever
become a topic of discussion
and controversy? But here we are, with
everyone from the Center for Disease
Control and Prevention (CDC) to PA
Department of Health (DOH) to local
health departments, and of course your
County Coroner weighing in on how
to certify the cause of death during the
COVID-19 pandemic. In addition to
confusion about medical terminology,
many health care facilities and providers in
the County were caught unprepared when
the PA Department of Health on March 6, 2020 (revised April
16, 2020) mandated that COVID-19 related deaths be certified
electronically1. As a coroner, I often complete multiple death
certificates daily and have a great deal of respect for the importance
of this document and what it means for public health and safety as
well as families.

The Basics
Let's start with a refresher on the basic anatomy of a DC,
because probably no one ever had so much as a lecture on this in
medical school. There are two parts, the "medical certification"
and the personal/demographic section. The cause and manner of
death are stated in the medical part, along with other items such as
tobacco use and pregnancy information (Figure 1). The personal/
demographic part is completed by a licensed funeral director.

In Pennsylvania, MDs, DOs, CRNPs,
PAs or coroners and medical examiners
can pronounce death and medically certify
the cause and manner of death. RNs can
pronounce a death, but are not authorized
to certify the cause and manner of death.
In Pennsylvania, state law [16 P.S.
§1218-B (a)] lists the types of deaths
which fall under the jurisdiction of the
coroner. They include "deaths known or
suspected to be due to a contagious disease
and constituting a public health hazard."
This is the reason we require such deaths
to be reported to my office. In almost all
cases, we simply take a report, with the investigation limited to a
standard set of questions. If the death is attributed to COVID-19,
a natural manner of death, and the attending health care provider
is willing and able to complete the death certificate, we authorize
release of the body to the funeral home.

Entering the Cause of Death
The CDC and others are particular about the kinds of
conditions and events that can be listed as a cause of death; they
also want to see a logical sequence. As it states right on the death
certificate, "DO NOT enter terminal events such as cardiac arrest,
respiratory arrest, or ventricular fibrillation without showing the
etiology." Whatever is entered last in the cause of death section is
the underlying cause of death, so it is the most important one to
get right. It must logically have led to or caused the terminal or
intermediate events on the preceding lines.
continued on next page >

(Figure 1)

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