Singapore — Could five migrant workers infected with the coronavirus, but who died of other causes or diseases, be reclassified as having died of Covid-19?
If this is possible, according to a report on Thursday (May 7) by activists Kirsten Han and Kokila Annamalai, it could help their families collect certain insurance payments.
An Agence France Presse report on Thursday (May 7) says that the list of manifestations of Covid-19 has gone beyond flu-like symptoms to other major organs also getting affected, such as the heart, kidneys and brain. In some patients, the illness pushes immune systems into overdrive, a serious symptom known as a cytokine storm.
Children, who were once believed to be largely immune to Covid-19, are now getting infected, with some showing a rare and painful inflammatory disorder.
According to the AFP report: “Dozens of medical studies in recent weeks have detailed other potentially lethal impacts including strokes and heart damage.”
In Singapore, 20 people have died of Covid-19. Six others who tested positive have died from other causes. Among them are the five for which reclassification is sought by the activists.
- A 32-year-old Indian national, Suppaiah Shanmuganathan, who died on April 8, and was confirmed positive for Covid-19 after his death. The cause of his death is listed as ischaemic heart disease (Case 1604).
- A 40-year-old Malaysian work permit holder, who tested positive for Covid-19 on April 17, and died the following day of a heart attack. According to the Ministry of Health, the heart attack was not because of Covid-19 complications (Case 4754).
- A 46-year-old Indian national, Alagu Periyakarrupan, who had been warded at Khoo Teck Puat Hospital for Covid-19, and was found dead at a stairwell in the hospital on April 23. His death is under investigation.
- A 47-year-old Bangladeshi whose test came out positive after his May 1 death, and whose death is also under investigation. (Case 17410)
- A 44-year-old Bangladeshi, who died of a heart attack on May 5. He had a previous heart attack on April 29, which is also when he tested positive for Covid-19.
As to why the deaths of the five men are not considered as part of the official count for Singapore, the activists say this could be because of guidelines set by the World Health Organisation (WHO), which says that a Covid-19 death is one that results from “a clinically compatible illness, in a probable or confirmed Covid-19 case, unless there is a clear alternative cause of death that cannot be related to Covid disease (e.g. trauma)”.
WHO added that “persons with Covid-19 may die due to other conditions such as myocardial infarction. Such cases are not deaths due to Covid-19 and should not be certified as such”.
The activists wrote that they had asked the MOH if it followed WHO guidelines for the classification of deaths, and added that there is evidence in Ireland, Spain and well as other places linking Covid-19 to blood clots, which causes a greater risk of strokes and heart attacks.
They also sent questions to the ministry concerning the classification of deaths, including whether there have been local patients who have experienced blot clots that led to heart attacks and strokes, and whether it would consider re-classifying previous deaths.
A day later on Friday (May 8), Yahoo News Singapore asked the MOH in a virtual press conference about how the cause of death for coronavirus-related fatalities is determined.
Associate Professor Kenneth Mak, the Director of Medical Services, said that attending doctors are the ones who declare a patient’s cause of death. They determine whether the death of a patient is because of Covid-19.
He said MOH has been “quite transparent” concerning all Covid-19 related deaths, adding: “Our approach really is first to ask ourselves: Is this directly attributable to Covid-19 infection, or complications related to Covid-19 infection? In which case, if they are, we will report them as such.”
“Even if they were not due to Covid-19 infection, then they would be reported still, but we will not necessarily ascribe them to Covid-19 unless we have been informed by the medical authorities, whether the doctors attending to the patient or the court if these were made coroner’s cases. If they were telling us directly that these were deaths attributable to Covid-19 infection, then we will be reporting them as such.” /TISG