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Dr Gérald Kierzek (Medical Director of Doctissimo)
The question has come up regularly since the start of the pandemic: are the dead counted as having died from Covid-19 really because of the virus? A German study seems to confirm this. For Dr. Gérald Kierzek, emergency physician and medical director of Doctissimo, this kind of study remains “to be taken with a grain of salt”.
Death from Covid? Or was the virus only an accelerator of death? These are the questions that German pathologists have been asking since the start of the pandemic. They therefore carried out autopsies in April 2020 and had the idea of listing their results in a national register, called DeRegCOVID. The Institute of Pathology at the RWTH University Hospital in Aachen, Germany, is behind the first study based on this registry. It is published in The Lancet Regional Health Europe.
A thousand autopsies performed
This register is the first initiative in the world in this area. It collects and records a whole series of information and samples taken from deceased patients, according to ethical and legal requirements. Between the months of April 2020 and October 2021, 1,129 patients were autopsied, representing 69,271 data and 18,674 samples collected.
Within this cohort, only 1,094 cases could be retained for this study, because the criteria were both being positive for SARS-CoV-2 and not having been vaccinated. A fairly low number, to which must be added the lack of data on patients who died out of hospital, for lack of autopsy.
More than 80% of deaths due to Covid-19
The scientists therefore studied the sequence of events that led to the death of these patients, from infection and the first symptoms, until death. Their job was to identify the immediate cause of death, finding out what pathology was responsible. But they also identified each time an underlying cause, which precedes the first and which leads to this pathology which will cause death. According to their findings, 86% of patients died from Covid-19. For the remaining 14%, the pathology “only” favored death, without causing it directly. The study also showed that during the first two waves, deaths occurred mainly in the second week after the onset of symptoms.
More men affected by deaths
The study identified 699 men for 395 women. It showed that Covid-19 affected patients aged 80 and over during the first wave, and that patients were much younger during the following two waves. Deaths most often occurred due to diffuse alveolar damage due to acute respiratory distress syndrome.
Later deaths were more caused by multi-visceral failure. The third most important cause of death was represented by pulmonary superinfections.
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“A study that has limits”
According to Dr. Gérald Kierzek, this study should be taken “with tweezers”: “This is a study with a limited number of patients, a little over a thousand, which is not enough to draw such important conclusions. In addition, we do not know if the virus was an accelerator of death because of the pathologies present in the patients or if it is really the only cause. On the other hand, what stands out is that the pulmonary embolisms were well taken care of, thanks to the diagnostic and prevention protocols”.