Dutch GPs asked to add to coronavirus death records

Move to include deaths outside hospitals should improve accuracy of statistics

The former assembly hall of the Dutch House of Representatives being prepared for meetings of the parliament’s lower house during the coronavirus crisis, The Hague. Photograph: Bart Maat/EPA

The former assembly hall of the Dutch House of Representatives being prepared for meetings of the parliament’s lower house during the coronavirus crisis, The Hague. Photograph: Bart Maat/EPA

 

Family doctors in the Netherlands have been asked to keep a register of deaths they believe may have been caused by Covid-19 in an attempt to supplement the official daily record of deaths in hospital – a move that could show the real toll is up to twice what was previously thought.

On Wednesday the Dutch public health institute, RIVM, showed the total number of fatalities so far had broken through the 3,000 barrier at 3,134. However, when that figure is supplemented with likely Covid-19 deaths in nursing homes and private homes, it is inevitably considerably higher.

The decision to widen the registration of deaths was made by the Association of General Practitioners on foot of figures from the central statistics bureau that have been showing deaths in excess of the average since the pandemic began – though at a level much higher than the RIVM.

“We are seeing a very large number of patients at home and in nursing homes who are suspected of having Covid-19 but who are never tested because hospitalisation doesn’t necessarily make sense in all cases,” said Jochen Cals, professor of general practice at Maastricht University.

When such patients die, it is often the case that a family doctor will register the cause of death as a complication of a pre-existing condition, such as heart disease, for example, because there’s simply no way of definitively establishing that the cause was coronavirus.

“As a result, these patients simply don’t exist in any official Covid-19 statistics, though in reality nearly all family doctors have their own lists of suspected coronavirus deaths.

“I believe we should be more careful in ensuring our figures are as accurate as possible, to reflect the hard work and bravery of the healthcare professionals involved and to respect the grief of loved ones.”

Online system

The new statistics will be collated – separately from the RIVM figures – using an online healthcare platform, zorgdomein.nl, used by about 90 percent of Dutch GPs. They’ll also be able to upload statistics retrospectively.

“If 50 percent of GPs or more contribute it should make a dramatic difference to the overall statistical picture,” said Prof Cals. “Doctors won’t be correct in every case, but in badly hit areas such as Brabant and Limburg, this will be particularly important.”

The public health institute says it is looking at options for a region-by-region easing of the lockdown, with the possibility of the northern provinces of Groningen, Friesland and Drenthe emerging first because their level of disease is “low and stable”.

At the same time teachers have expressed disquiet at the possibility of a phased reintroduction of schools in some areas from May 3rd, with the emphasis on final-year teenagers in smaller classes to allow social distancing.

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