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New COVID-19 post-death testing explained

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In line with a directive issued by the World Health Organisation, the Western Cape Department of Health has announced that all sudden deaths or those which occur at home will need to be tested for Covid-19.

“Mortality due to Covid-19 is an important population-based measure of the pandemic. When testing for SARS-CoV-2 is constrained, death information becomes even more important. For this reason, it is imperative that clinicians in South Africa are aware of their obligation under law to report accurate caused of death on the South African death notification form,” reads the document signed by Director General of Health Dr Sandile Buthelezi on July 21st 2020.

“This means that clinicians are bound by law to report Covid-19 as a cause of death in cases where this has been confirmed, as well as in cases where, in their opinion, this is the most probable cause of death, even if a test result is not available to confirm this,” it continued.

Speaking to VOC’s Breakfast Beat on Tuesday, head of health in the province Dr Keith Cloete said that specimens are required to be taken for Covid-19 before a death certificate is issued. He reminded residents that a medical practitioner, ambulance or doctor will still be required to pronounce the cause of death before a death certificate can be issued and the extra test, as per the norm.

“It is a national guideline and, in the Western Cape, we have more or less been doing that from the start anyway. Be mindful that all unexplained deaths could potentially have COVID-19 associated with it so we have been asking people all along- anybody that has an unexplained death at home- that a sample is preferable,” he said.

Cloete explained that it follows concern that some Covid-19 cases may have slipped through the cracks and this is one method of ensuring the reliability of COVID stats. According to Cloete, the overall death toll in the province is higher than predicted and the department is coping better because Covid-19 cases have lessened in the past 4-6 weeks.

“An MRC weekly report has checked data from home affairs to make sure we don’t miss COVID deaths. There are actually quite a few deaths that are not being picked up in the death notifications for the COVID19, because the unnatural deaths are higher than expected,” he said.

Meanwhile, MJC medical advisor Salim Parker also stated that there was an excess of 17-20 thousand deaths compared to previous years.

“About 20K plus more people have died than we expected. Yes, 10k have died from COVID but there are still more that are unaccounted for. That is why the (health) minister wants to know, is it due to COVID or reasons other than that,” he explained.

Cloete also pointed out that the latest requirement does not put added strain on families, but rather medical practitioners, who have now been requested to take a test sample before issuing the death certificate. The results of this test, Cloete said, would be available in around 24-36 hours and should not affect burial procedures to a large extent.

He explained that it is thereafter the hospital’s responsibility to inform the family of the result. Previous concerns around having sufficient test has been resolved as kits have been made available.

“In many cases, the Person Under Investigation (PUI) is managed as if they have Covid-19 while awaiting the results. It could be that a person passed away before the test result has come back and in it is still incumbent on the hospital to contact the family and say it was negative or positive,” he said.

Parker meanwhile said that the department will still need to draw up Standing Procedures on how this requirement will be implemented. Only then, Parker said, will the details be ironed out:

“The mayet (deceased) does not need to be taken to a place like Tygerberg as suggested on social media- that is completely wrong. What we don’t know (yet) is who has to do it (test), where does this swab get taken from and where does it get sent to. That must still be legislated,” said Parker.

He further called on clarity around whether toekamanies will also be permitted to conduct the new test and how they would go about doing so.

“The Islamic Medical Association is very willing to teach toekamanies, if it that is part of the procedures that toekamanies can do,” he added.

VOC


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