Dying “from” or “with” COVID-19 during the Pandemic: Medico-Legal Issues According to a Population Perspective

Fabio De-Giorgio, Vincenzo M. Grassi, Eva Bergamin, Alessandro Cina, Franca Del Nonno, Daniele Colombo, Roberta Nardacci, Laura Falasca, Celeste Conte, Ernesto d’Aloja, Gianfranco Damiani and Giuseppe Vetrugno
Additional contact information
Fabio De-Giorgio: Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Vincenzo M. Grassi: Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Eva Bergamin: Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Alessandro Cina: Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
Franca Del Nonno: Pathology Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy
Daniele Colombo: Pathology Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy
Roberta Nardacci: Laboratory of Electron Microscopy, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy
Laura Falasca: Laboratory of Electron Microscopy, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy
Celeste Conte: Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Ernesto d’Aloja: Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
Gianfranco Damiani: Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
Giuseppe Vetrugno: Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy

IJERPH, 2021, vol. 18, issue 16, 1-13

Abstract: There is still a lack of knowledge concerning the pathophysiology of death among COVID-19-deceased patients, and the question of whether a patient has died with or due to COVID-19 is still very much debated. In Italy, all deaths of patients who tested positive for SARS-CoV-2 are defined as COVID-19-related, without considering pre-existing diseases that may either contribute to or even cause death. Our study included nine subjects from two different nursing homes (Cases 1–4, Group A; Cases 5–9, Group B). The latter included patients who presumably died from CO poisoning due to a heating system malfunction. All subjects tested positive for COVID-19 both ante- and post-mortem and were examined using post-mortem computed tomography prior to autopsy. COVID-19 was determined to be a contributing cause in the deaths of four out of nine subjects (death due to COVID-19; i.e., pneumonia and sudden cardiac death). In the other five cases, for which CO poisoning was identified as the cause of death, the infection presumably had no role in exitus (death with COVID-19). In our attempt to classify our patients as dying with or due to COVID-19, we found the use of complete assessments (both histological analyses and computed tomography examination) fundamental.

Keywords: COVID-19; post-mortem computed tomography; CO intoxication; pneumonia; causality (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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