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To get an accurate count of the number of people in the U.S. killed by the novel coronavirus, which causes the respiratory disease COVID-19, it’s important that we conduct widespread testing of both the general population and those who have died.
People who suffer from a number of preexisting conditions are more likely to die if also infected by this new coronavirus. If they tested positive for COVID-19 that should be included on their deaths certificates.
Many people have said we are at war with the coronavirus – and apt analogy. But if we are to fight and defeat this enemy, we need to understand the enemy’s strength and where it is mobilized against us. Testing for the presence of the virus among both the living and those who have died gives us this vital public health information.
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Testing people who have died for the presence of the coronavirus is simple. All that is needed is a nasal swab for DNA testing at medical examiner or coroner mortuaries or at funeral homes. Very little additional protective gear would be needed for those administering the test, and anyone preparing bodies for burial or cremation can perform the test.
It’s obvious why testing of the living is needed – identifying people hit by the coronavirus can help doctors treat them and can tell us who needs to be isolated to keep from infecting others. But many people may wonder why we need to test people who have died – those who are sadly beyond help.
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When we learn the age, sex and race of those killed by the coronavirus – as well as where they died – we can better trace the spread of the virus and notify people who have been in contact with the deceased so they can be tested and isolated until they know if they have also been infected.
The public health importance of including any infecting microbes – whether viral or bacterial – on death certificates has been repeatedly demonstrated in responses to the 1918 Spanish flu, the 1957 Asian flu, the 1968 Hong Kong flu, the 2002 SARS flu and current cluster spreads of measles in the United States and cholera in Haiti.
The coronavirus is not only a dangerous and highly contagious pathogen, but one that can kill otherwise healthy people by itself, most commonly by producing a severe pneumonia.
The coronavirus can also hasten death in people with preexisting medical conditions such as chronic heart disease, diabetes, asthma, weakened immune systems and chronic obstructive pulmonary disease. These conditions make people who would otherwise go on living particularly vulnerable to the coronavirus.
In most viral infections the individual becomes symptomatic with fever, cough and shortness of breath days before being able to infect others – in time to stay at home and take steps to prevent making others ill.
The new coronavirus is different. A person infected with this virus may feel perfectly healthy while shedding viruses and infecting others for up to 14 days before becoming symptomatic. In fact, 20 percent or more of people infected by the coronavirus may not feel sick at all while unknowingly infecting others.
The only way to identify such asymptomatic virus spreaders is by extensive testing of the living and those who have died – not just by testing people who visit a doctor because they feel sick.
Fortunately, about 98 percent of people infected by this novel coronavirus will recover from the immediate ill effects of the pathogen. But everyone infected who survives will have to be not just identified but followed medically, because we don’t know if these people will develop further clinical illness in the future, such as chronic lung disease, heart disease or neurologic disease.
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Lung scarring has developed in some SARS survivors, and we need to see if this happens with patients who have been stricken with COVID-19. A brain disease – encephalitis lethargica (also known as von Economo’s disease), developed in some 1918 flu survivors, followed by Parkinson’s disease.
Right now we don’t know how many infected asymptomatic individuals are walking around unaware that they are sick or contagious, or how many people who apparently died from other causes were in fact infected with the coronavirus.
COVID-19 is a brand new disease, never before encountered in humans. So we also know little right now about its future course, how it will behave and what types of strategies have to be developed to contain and cure it.
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Testing the living and those who have died will play a key role in helping us defeat the coronavirus enemy that has now confined most of us to our homes and ravaged our economy, as well as stricken so many.
Our goal, of course, is to develop better treatments, a cure and ultimately a vaccine to make us immune to the coronavirus that causes COVID-19. Just as vaccines have largely eliminated smallpox, polio, measles and other communicable diseases that once sickened millions, we look forward to the day that COVID-19 may be a disease we know only from history books and unfortunate memories.
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