This is all very well but relies on all involved medical personnel as acting with complete propriety. Where an autopsy or a CT scan has been conducted there can be no doubt of the diagnosis.
But how often are autopsy or CT scan results available? In a busy emergency ward such procedures can easily be omitted. The cases of people dying in accidents who are said to be covid victims cast a particularly troublesome light upon the rigor of covid diagnoses. Are such diagnoses invariably accompanied by an autopsy or scan? It seems unlikely.
The authors below are talking about best practic but the issue is how often best practice is followed. There are good reasons to believe that it often is not
Conspiracy theorists claim doctors are inflating the pandemic’s death toll by putting COVID-19 on the death certificate of everyone who died with the virus. But – the theory goes – they didn’t die from COVID, they died with COVID.
But the head of pathology at the Victorian Institute of Forensic Medicine has autopsied dozens of patients with COVID-19.
And on her table, she says, the signs of the virus are clear. “Absolutely, it is very obvious. The post-mortem CT [scan] changes are striking. The appearances of their lungs in the autopsy rooms are striking.”
The claim that COVID-19 death counts are over-inflated has been a regular go-to for conspiracy theorists and lockdown opponents throughout the pandemic.
A diverse group has promoted the idea, including former US president Donald Trump.
The claims are standard boiler-plate for conspiracy theorists, who often rally around the belief that powerful people in society are trying to deceive the public for their own benefit, says Mathew Marques, who lectures in social psychology at La Trobe University.
“Rarely is there a new conspiracy theory that is surprising, when they all follow the same structure or pattern – lay beliefs about a secretive group of often powerful actors engaging in a malevolent plot against a society,” he says.
In hospitals, it is easy to work out if a person has died from COVID-19 – they wouldn’t be in an ICU ward on a ventilator otherwise. The Institute of Forensic Medicine handles harder cases: people who died suddenly in the community while they had COVID-19.
In many cases, like car accidents, the cause of death is obvious. In others, it requires a lot more work. The team runs a computerised tomography (CT) scan, and then if needed conducts an autopsy.
The most obvious signs a person has died from COVID-19 – not with it – are seen in the lungs, says forensic radiologist Dr Chris O’Donnell.
On a CT scan, the lungs are typically a dark black void – the scanner’s representation of space filled with oxygen.
In people who die of COVID-19, “that air is completely replaced by inflammatory tissue that fills up the air sacs and stops the exchange of oxygen,” says Dr O’Donnell.
“They struggle to breathe and even when they do get a breath in, none of the air they breathe can get into their blood because their lungs are blocked full of this inflammatory tissue. They die of lack of oxygen.”
In the disease’s early stages, the CT scan shows the lungs clouding over with inflammatory tissue. Radiologists refer to this as “ground glass”.
In late-stage disease, the virus has completely filled the lungs with inflammatory tissue. “We call that a white-out, when there’s no air in the lung,” Dr O’Donnell says.
These cases are clear-cut and are added to the pandemic’s official death toll. But when it is clear after autopsy that COVID-19 did not contribute to death, they are not added, Dr O’Donnell says.
“That’s our role: to look into these cases more thoroughly. We’re working to find the real truth, whether people have died of COVID or whether it’s something else.”