As an intensivist working in COVID ICUs, the unfortunate reality is that many of my patients have died from complications related to COVID-19. At some point during this pandemic, there was a concern that physicians were attributing many deaths to “presumed” COVID-19, and that this was inflating the true mortality statistics. Keep in mind that the falsification of a death certificate can result in significant financial AND legal ramifications. I only report COVID-19 if a patient truly tests positive.
In Texas, we use an electronic service to file death certificates called TxEVER. I am “assigned” patients for whom I need to complete death certificates. Most of their demographic information has already been filled out, so my job is to accurately convey their medical cause of death through a timeline. In the example below, I’ve created a sample entry for a hypothetical patient who started off with COVID-19 infection (the underlying cause of death, UCOD) which progressed to hypoxemic respiratory failure, then acute renal failure, and then septic shock.
Per the CDC, the UCOD is the “disease or injury which initiated the train of morbid events leading directly to death OR the circumstances of the accident or violence which produced the fatal injury.” This should be reported on the lowermost line. Of note, the “Manner of Death: Natural” indicates that the cause of death was solely or almost entirely due to a disease or the aging process.