A Year of Deaths Due to or With COVID-19 Under Universal Postmortem Testing in San Francisco.

Rand A Miyashiro, Willi McFarland
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Abstract

The Health Officer of the City and County of San Francisco, California, issued the order that all decedents were required to have a documented COVID-19 test effective from June 2020 to June 2021. The justification for the requirement was that complete data on COVID-19 status at the time of death were needed to help protect first responders and funeral home workers, identify missed cases, and characterize the places of death for otherwise unknown COVID-19 cases. To fill the gap in COVID-19 testing for all decedents, particularly among persons dying outside of hospitals, a specialized Decedent Testing Unit was created along with an increased capacity of the Office of the Chief Medical Examiner. From July 1, 2020, to June 30, 2021, the Decedent Testing Unit and Office of the Chief Medical Examiner provided postmortem testing results for 2776 decedents. Of these, 80 tested positive for COVID-19 for a positivity rate of 2.97%. The largest number of COVID-19-positive specimens were collected from persons who died at home (n = 37, 46.3%), followed by those who died in hospice (n = 20, 25.0%), other places outside of homes or facilities (n = 8, 10.0%), and in skilled nursing or long-term care facilities (n = 7, 8.8%). Follow-up of California death records found that 17 of these 80 cases (21.3%) had COVID-19 listed as one of the causes of death, 22 (27.5%) mentioned COVID-19 under "other conditions," and 41 (51.3%) made no mention of COVID-19. In the context of providing the COVID-19 status of decedents not otherwise known to have infection, our data help gauge the likelihood of missing deaths due to or with COVID-19 and inform future public health decisions on whether to require universal postmortem testing with COVID-19 resurgences or with new deadly epidemics.
在旧金山普及尸检的一年中,因 COVID-19 或 COVID-19 导致的死亡人数。
加利福尼亚州旧金山市和县卫生官员发布命令,要求所有死者在 2020 年 6 月至 2021 年 6 月期间接受有记录的 COVID-19 检测。提出该要求的理由是,需要有关死亡时 COVID-19 状态的完整数据,以帮助保护急救人员和殡仪馆工作人员、识别遗漏病例,并确定原本未知的 COVID-19 病例的死亡地点特征。为了填补所有死者 COVID-19 检测方面的空白,特别是在医院外死亡的人员中,我们成立了一个专门的死者检测小组,同时提高了首席法医办公室的能力。从 2020 年 7 月 1 日至 2021 年 6 月 30 日,死者检验小组和首席验尸官办公室为 2776 名死者提供了验尸结果。其中,80 人的 COVID-19 检测呈阳性,阳性率为 2.97%。COVID-19阳性标本中,在家中死亡者的标本最多(37 份,占 46.3%),其次是在临终关怀机构死亡者(20 份,占 25.0%)、在家庭或机构以外的其他地方死亡者(8 份,占 10.0%)以及在专业护理机构或长期护理机构死亡者(7 份,占 8.8%)。对加州死亡记录的追踪发现,在这 80 个病例中,有 17 例(21.3%)将 COVID-19 列为死因之一,22 例(27.5%)在 "其他情况 "下提及 COVID-19,41 例(51.3%)未提及 COVID-19。我们的数据有助于衡量因COVID-19或感染COVID-19而导致死亡的遗漏可能性,并为未来公共卫生决策提供信息,以决定是否在COVID-19死灰复燃或出现新的致命流行病时要求进行普遍尸检。
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