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Covid-19 case dies of heart disease in Singapore, but not included in official death tally

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There are 10 such individuals who have tested positive for Covid-19 but are listed as having died from other causes

Singapore—On Thursday (June 11), the Ministry of Health (MOH) announced in its daily update that another person in Singapore who was positive for Covid-19 died. However, like several other people in the past few months who were also positive for the coronavirus, his death is not considered to be part of the national tally of fatalities stemming from Covid-19.

The latest death is that of a 44-year-old male Indian national who died on June 8. The MOH update says he had been treated at a General Practitioner clinic on May 28 after developing pain in his chest and and the upper central part of his abdomen.

However, by the June 8, he was found unconscious in his home, and brought to the emergency room of Singapore General Hospital. The cause of death listed for the man is ischemic heart disease, also known as coronary heart disease. Put simply, it means that his heart was not getting enough blood or oxygen. This happens when the arteries supplying blood to the heart become to narrow.

It was confirmed that the man had Covid-19 on June 10, only after his death.

In the footnote to the MOH update it says, “Only cases where the attending doctor or pathologist attributes the primary or underlying cause of death as due to COVID-19 infection will he be added to the COVID-19 death count. This is consistent with international practice for classifying deaths.”

There are 10 such individuals who have tested positive for Covid-19 but are listed as having died from other causes.

The disease Covid-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is a novel coronavirus, meaning that it has not been observed in humans previous to last year, when it was discovered in Wuhan, a city in central China. Because it affects people’s respiratory systems, it has thus far been considered a respiratory disease.

The World Health Organization has said 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”.

However, new studies are saying that Covid-19 may be a blood vessel disease just as much as it is a respiratory infection. There have been a number of symptoms in infected patients that are normally not present in persons with respiratory infections, including the so-called “Covid Toe” as well as a multi-system inflammatory syndrome found in children, which certainly defies the early advice that children seemed to be less vulnerable to the infection.

A study published in the well-respected medical journal The Lancet in April said that “Cardiovascular complications are rapidly emerging as a key threat in coronavirus disease 2019 (COVID-19) in addition to respiratory disease,” although admittedly, information concerning this aspect of the infection remains incomplete. The study also noted that “the disease has such a variety of presentations and makes it potentially more dangerous.”

Commenting on the study, the Chairman of the Center for Global Health Innovation and Global Health Crisis Coordination Center, Dr Russell Medford, said, “These findings are consistent with a growing body of scientific and clinical evidence that strongly suggests that the SARS-CoV2 virus can infect and damage multiple organs in addition to the lungs, such as the kidney, heart, intestines and liver, by targeting the endothelial cells that line the inner surface of their blood vessels.”

In Singapore, several of those who were positive for Covid-19 but are not considered as part of the official death count are migrant workers, which activists Kirsten Han and Kokila Annamalai wrote about early in May.

At that point, they listed five migrant workers as follows:

  1. 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 ischemic heart disease (Case 1604).
  2. 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.
  3. 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.
  4. A 47-year-old Bangladeshi whose test came out positive after his May 1 death, and whose death is also under investigation. (Case 17410)
  5. 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.

Ms Han and Ms Annamalai had asked the MOH regarding the classification of Covid-19 deaths and whether it would consider re-classifying previous deaths.

There are practical considerations to the reclassification of Covid-19 deaths. As the activists point out, according to migrant workers ItsRainingRaincoats points out, “[While] the bereaved families (in both cases widows with young children) are unlikely to get any insurance payment for deaths classified as heart attacks, they may be eligible to insurance payment for Covid related deaths especially if transmitted at work sites or related to work.” —/TISG

Read related: Activists: Could deaths of 5 infected migrant workers be reclassified?

Activists: Could deaths of 5 infected migrant workers be reclassified?

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