Cusack Denis A
Forensic and Legal Medicine, School of Medicine, University College Dublin, Ireland; Coroner's District of Kildare, Ireland.
J Forensic Leg Med. 2020 Nov;76:102072. doi: 10.1016/j.jflm.2020.102072. Epub 2020 Oct 31.
All Covid-19 deaths and all nursing home and residential home deaths in Ireland must by law be reported to the Coroner, the independent Judicial Officer of the State, in the District in which they occur. This enables accurate and early collation of these death reports. Between January 1, 2015 and June 30, 2020 3342 deaths were reported to the Coroner's District for Kildare. From March 11, 2020, when the first Covid-19 death occurred in Ireland in County Kildare, to June 30, 2020 there were 1738 Covid-19 deaths nationally of which 139 were reported in Kildare with 113 (81%) of these deaths in nursing and residential homes. The calculated excess number of deaths notified for January to June 2020 compared with 2015-2019 was 198 (41%) of the 484 total deaths reported with a 131 (45%) excess in the 293 deaths in nursing and residential homes. Covid-19 deaths accounted for 70% and 86% of these excess deaths respectively. Following subtraction of the 18 non-natural cause deaths and 139 Covid-19 deaths from the total excess there remained an unexplained excess of 60 deaths due to natural causes in March to June of 2020 compared with 2015-2019. The peak excess total death percentage was 359% in April 2020, commencing with a small excess in March (30%), continuing into May (63%) and falling again in June (37%). In the nursing and residential home setting those excess death percentages were most marked at 527% in April, with 27% in March, 54% in May and 17% in June. Underlying medical conditions were recorded in 99% of those dying from Covid-19 and the average age of the deceased was 82.5 years with median of 78 years and 55% of those dying were female and 45% male. The clinical epidemiology and documented excess mortality of the reported deaths are chronicled and analysed to learn also about the future challenges with the continuing Covid-19 infection. A centralized national mortality database providing near real-time death certification enhances infectious disease surveillance and prompt clinical epidemiology and mortality excess studies and reduces under-reporting of Covid-19 deaths.
根据爱尔兰法律规定，所有新冠疫情死亡病例以及养老院和疗养院死亡病例，都必须向所在地区的验尸官报告，验尸官是国家独立司法官员。这样能准确且尽早地整理这些死亡报告。在2015年1月1日至2020年6月30日期间，基尔代尔验尸官辖区共报告了3342例死亡病例。从2020年3月11日爱尔兰基尔代尔郡出现首例新冠疫情死亡病例，到2020年6月30日，全国共有1738例新冠疫情死亡病例，其中基尔代尔郡报告了139例，这些死亡病例中有113例（81%）发生在养老院和疗养院。与2015 - 2019年相比，2020年1月至6月报告的死亡病例计算得出的死亡超额数为198例（占报告的484例总死亡病例的41%），养老院和疗养院的293例死亡病例中超额131例（45%）。新冠疫情死亡病例分别占这些超额死亡病例的70%和86%。从总超额死亡病例中减去18例非自然原因死亡病例和139例新冠疫情死亡病例后，与2015 - 2019年相比，2020年3月至6月仍有60例自然原因导致的不明超额死亡病例。2020年4月超额总死亡百分比峰值为359%，3月开始有小幅超额（30%），5月持续上升（63%），6月再次下降（37%）。在养老院和疗养院环境中，这些超额死亡百分比在4月最为显著，为527%，3月为27%，5月为54%，6月为17%。99%的新冠疫情死亡病例记录了基础疾病情况，死者平均年龄为82.5岁，中位数为78岁，死亡者中55%为女性，45%为男性。对报告死亡病例的临床流行病学和记录的超额死亡率进行记录和分析，以了解持续的新冠疫情感染带来的未来挑战。一个提供近乎实时死亡证明的全国集中式死亡率数据库可加强传染病监测、促进临床流行病学和超额死亡率研究，并减少新冠疫情死亡病例的漏报。
