By Peter Groarke and Sinead Harrington
29 April 2020
As Ireland continues to grapple with the effects of COVID-19, the government’s recent announcement on 10th April 2020 extended all current restrictions on freedom of movement until the 5th May 2020. The country is rightfully being praised for its diligent adherence to the restrictions but as ‘lockdown fatigue’ begins to set in, we must all be wary of allowing complacency to undo all the good work so far.
The national figure of cases and death rates have moved from an initial continual daily increase to one where we now read of fluctuating peaks and troughs. Each week seems to contain dramatic statistics as Ireland experiences what experts have called “the surge” in cases of COVID-19.
On Tuesday the 28th April, it was announced that the number of people that had died from COVID-19 in Ireland stood at 1,159. The total number for positive cases of coronavirus is now 19,877 with Dublin experiencing the most confirmed cases.
The Government announced new emergency legislation which recognised the extraordinary measures that needed to be put in place in order to safeguard human life and public health. The Health (Preservation and Protection and other Emergency Measures in the Public Interest) Act 2020 was signed into law on 20 March 2020. Under this Act, “Exceptional Provisions” are introduced, having regard to “the manifest and grave risk to human life and public health” posed by the spread of Covid-19. These emergency measures confer a power on the Minister for Health to restrict the freedom of movement of individuals and to provide for appropriate measures to enable the authorities to enforce said powers. For example, medical officers may take certain actions such as detention in respect of individuals regarded as “potential sources of infection”, in order to limit the spread of COVID-19 and prevent the Irish health system becoming overwhelmed.
Despite plentiful knowledge being shared daily on COVID-19, one aspect that causes concern is the reporting of death as a result of COVID-19 to the Coroner’s Service. The Coroner’s Service is responsible for the forensic and medico-legal investigation of certain categories of death in Ireland. Its roles and functions are set out in the Coroners Act 1962-2019, however a coroner’s primary duty is the investigation of sudden and unexplained deaths in Ireland. This may require a post-mortem examination, sometimes followed by an inquest.
On 20 February 2020 the Minister, through the Infectious Diseases (Amendment) Regulations 2020, included COVID-19 on the list of notifiable diseases under the Infectious Diseases Regulations 1981 (the “Regulations”).
In a statement about its role in the handling of deaths from Covid-19 on 11 March 2020, the Coroners Society of Ireland said that where a patient had been diagnosed with Covid-19, the death must be reported to the local district coroner, but in most cases a post-mortem would not be necessary “unless other circumstances are present”. In its statement, the Coroner’s Service outlined a number of likely scenarios and confirmed that in most cases a post-mortem would not be required “unless other circumstances are present and the law mandates an autopsy to be directed by the coroner”.
Possible scenarios include where a patient dies in hospital while viral swabs are awaited and where a patient dies in hospital from respiratory failure or adult respiratory distress syndrome before investigation for coronavirus takes place. Swab tests should be taken and if the result is negative a post-mortem can be undertaken if the coroner so directs.
If the test is positive, no post-mortem is required.
Where there is a death in the community with “circumstantial suspicion for Covid-19 infection” but no investigation has taken place before death, the remains should be transferred to the district coroner for viral swab testing. It is also stated that in such cases where the viral screening or post-mortem was finished the “body will be released to the person entitled to possession under the law (usually the family or next of kin) and funeral arrangements and interment or other arrangement are then a matter for the family and their funeral directors”.
Figures from the Coroner’s service show that on average, more than 2,000 inquests a year are held. However, in the midst of the current crisis, there is a growing concern over the possible under-reporting of all COVID-19 deaths, particularly in nursing homes and other residential settings. The Irish Times reports that “analysis of online death notices in recent weeks have suggested a level of excess mortality not captured in official figures”. Additionally Dublin coroner Dr Myra Cullinane has also expressed her concern on this matter and, as a result, she has written to medical staff in hospitals and other locations who are responsible for completing death certificates, advising that compliance with the requirement to report “any death in the context of proven or suspected Covid-19” is absolutely necessary. Moreover, Dr Tony Holohan, Chief Medical Officer in Ireland, has reassured that these residential sectors of Irish society have now been made a priority area for Irish public health officials. It is hoped that we will see a more accurate number of the cases of deaths in Ireland due to COVID-19.
Across the water in the UK, we see that the Coronavirus Act 2020 received royal assent on 25 March 2020. This emergency legislation provides guidance on Medical Certificate Cause of Death (MCCD) in the UK. The Act states that the duty on a medical practitioner to notify the coroner only applies during the emergency period where it is reasonably believed that there is no other medical practitioner who may sign the MCCD. COVID-19 has now been listed as a notifiable death under the Health protection (Notification) Regulations 2020 which means it is notifiable to the Public Health England. However, unlike Irish legislation, although COVID-19 is a notifiable disease under the Act, this does not mean a report of death to a coroner is required by virtue of its notifiable status (the notification is to the Public Health England) and there will often be no reason for deaths caused by COVID-19 to be referred to a coroner.
The available expert evidence suggests that the curve is flattening and as a result of our adherence to restrictions we have undoubtedly saved many lives in Ireland.
Let this light at the end of the tunnel not blind us.
We should still push for more accurate reporting on Covid-19 related deaths in Ireland and widespread testing which will highlight a greater need for vigilance in areas where the most vulnerable in society reside.
For more information on the content of this insight please contact:
Peter Groarke, Partner | E. peter.groarke @rdj.ie | T. + +353 21 4802782