The World Health Organisation (WHO) has set international guidelines for formatting the cause-of-death section on medical certificates as well as the rules and guidelines for clinical coders to select the underlying cause of death for cause-of-death statistics.
An "underlying cause of death" is defined by WHO as: "the disease or injury which initiated the train of morbid events leading directly to death, or, the circumstances of the accident or violence which produced the fatal injury".
Due to the public health importance of Covid-19, the WHO has directed that the coronavirus strain be recorded as the underlying cause of death, that is, the disease or condition that initiated the train of morbid events when it is recorded as having caused or contributed to the death.
In New Zealand, the Ministry of Health also directs health practitioners to Australian Bureau of Statistics guidelines when certifying causes of death for people who died of, or with Covid-19. These guidelines are also based on the World Health Organisation recommendations.
The Australian guideline states Covid-19 should be recorded on the medical cause of death certificate for all decedents where the disease caused, or is assumed to have caused, or contributed to a death.
Existing conditions, such as coronary artery disease, chronic obstructive pulmonary disease, diabetes, cancer, or disabilities that may have also contributed to death should be noted in the Medical Certificate of Cause of Death.
An emergency code "U07.1 COVID-19" is assigned when Covid-19 is mentioned on the death certificate.
Despite this apparently overarching definition of Covid in relation to death, the World Health Organisation estimates the actual death toll is under-reported. The organisation has backed this assertion by calculating excess morbidity rates - the extra numbers of deaths that have occurred compared with what would have been expected without Covid-19.
In 2020, it said Covid-19 excess mortality estimates ranged from 1.34-1.46 million in the Region of the Americas to 1.11-1.21 million in the European Region. This amounted to about 60 per cent (Americas) and 50 per cent (Europe) more than reported Covid-19 deaths, respectively
Research published in the peer-reviewed journal The Lancet earlier this month, revised the excess morbidity rates using data from 74 countries and 266 states and territories between January 1, 2020, and December 31 last year.
It found the number of people worldwide who died because of the pandemic in its first two years may total more than 18 million - three times more than the reported global death toll from Covid-19, which surpassed 6 million last week.
The overall picture is a confronting one. Devastatingly, the global death rate is weighted by territories that, for various reasons, haven't successfully rolled out vaccinations.
The Financial Times reported on the tragic situation in Hong Kong. It found as recently as early February, 69 per cent of Hong Kong residents aged 80 and above were unvaccinated. The equivalent figure in New Zealand was 2 per cent.
Hong Kong's older demographic, in particular, declined readily available vaccines because early border closures and lockdowns had worked and there was "no Covid". The Omicron variant, as we know only too well, does not bend so easily to the will of precautions.
Omicron has also wreaked the worst toll among unvaccinated populations or where vaccines less potent against the variant than the BioNTech Pfizer inoculation were administered.
Every loss is terrible, but New Zealand has been fortunate indeed to have weathered this viral maelstrom better than most.
