Why is it important to correctly classify and report SARS-CoV-2 infections and COVID-19 deaths?

Abstract

 Background. In a public health emergency such as the coronavirus disease 2019 (COVID-19) pandemic, mortality surveillance is crucial, as it guides the public health response and serves as a measure of its effectiveness. It is therefore critical that deaths are uniformly and accurately classified, calculated and reported. 

Objective. To discuss the importance of making accurate COVID-19 diagnoses and correctly classifying COVID-19 deaths, drawing on the experience of the misclassification of HIV/AIDS deaths in South Africa (SA). 

Method. We performed an electronic literature search on PubMed, Google Scholar and EBSCOhost to identify studies with key words such as coronavirus, COVID-19, SARS-CoV-2 and mortality or death. Relevant studies were reviewed for suitability and used in the development of the argument. 

Results. In SA, from 6 May to 30 June 2020, an excess of 6 849 deaths were reported from natural causes among people >1 year old when using a revised base accounting for lower mortality during lockdown. Over this same period, the SA government reported 2 504 COVID-19 related deaths. Both overestimation and underestimation of deaths have significant implications for health policy and resource allocation, as was evident in SA when the misclassification of deaths during the period of HIV denialism led directly to fewer resources being spent on dealing with the prevention and treatment of HIV, which allowed the disease to spiral out of control. 

Conclusion. To ensure an appropriate public health response to COVID-19, accurate data on SARS-CoV-2 infections and COVID-19-related deaths are needed. The SA National Department of Health should develop clear guidelines on classification of deaths, and share this information with all those responsible for certifying deaths.