Excess Deaths During the COVID-19 Pandemic: Implications for US Death Investigation Systems

Researchers often have a need to conduct human tissue research using postmortem specimens. Medicolegal death investigation organizations are untapped areas for obtaining postmortem human tissues. Because death investigation organizations are not required by law to conduct or support research, an ethical dilemma exists in whether or not researchers should use cadaver tissues for research purposes. This paper analyzes the ethical issues of using human tissues through discussion of principles of biomedical ethics, respect for autonomy, nonmaleficence, beneficence, and justice. Policy makers, organ and tissue procurement organizations, medicolegal death investigation organizations, and scientists should be aware of these principles when considering researchers requests. The authors conclude that with Institutional Review Board approval and next of kin consent, there are prevailing reasons for using postmortem tissue for research.

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Death Investigation and Forensic Medicine in South Africa: Historical Perspectives, Status Quo, and Quo Vadis?

Academic Forensic Pathology ◽

10.1177/1925362120986678 ◽

2020 ◽

Vol 10 (3-4) ◽

pp. 115-130

Author(s):

Gert Saayman

Keyword(s):

South Africa ◽

Forensic Medicine ◽

Status Quo ◽

Historical Perspectives ◽

Quo Vadis ◽

Death Investigation

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Estimation of Excess Mortality and Years of Life Lost to COVID-19 in Norway and Sweden between March and November 2020

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083913 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3913

Author(s):

Martin Rypdal ◽

Kristoffer Rypdal ◽

Ola Løvsletten ◽

Sigrunn Holbek Sørbye ◽

Elinor Ytterstad ◽

...

Keyword(s):

Excess Mortality ◽

Age Groups ◽

Years Of Life Lost ◽

Regressive Model ◽

Epidemic Period ◽

All Cause Mortality ◽

Auto Regressive ◽

Expected Mortality ◽

Auto Regressive Model ◽

Excess Deaths

We estimate the weekly excess all-cause mortality in Norway and Sweden, the years of life lost (YLL) attributed to COVID-19 in Sweden, and the significance of mortality displacement. We computed the expected mortality by taking into account the declining trend and the seasonality in mortality in the two countries over the past 20 years. From the excess mortality in Sweden in 2019/20, we estimated the YLL attributed to COVID-19 using the life expectancy in different age groups. We adjusted this estimate for possible displacement using an auto-regressive model for the year-to-year variations in excess mortality. We found that excess all-cause mortality over the epidemic year, July 2019 to July 2020, was 517 (95%CI = (12, 1074)) in Norway and 4329 [3331, 5325] in Sweden. There were 255 COVID-19 related deaths reported in Norway, and 5741 in Sweden, that year. During the epidemic period of 11 March–11 November, there were 6247 reported COVID-19 deaths and 5517 (4701, 6330) excess deaths in Sweden. We estimated that the number of YLL attributed to COVID-19 in Sweden was 45,850 [13,915, 80,276] without adjusting for mortality displacement and 43,073 (12,160, 85,451) after adjusting for the displacement accounted for by the auto-regressive model. In conclusion, we find good agreement between officially recorded COVID-19 related deaths and all-cause excess deaths in both countries during the first epidemic wave and no significant mortality displacement that can explain those deaths.

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Construction of a demand and capacity model for intensive care and hospital ward beds, and mortality from COVID-19

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01504-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Christopher Martin ◽

Stuart McDonald ◽

Steve Bale ◽

Michiel Luteijn ◽

Rahul Sarkar

Keyword(s):

Intensive Care ◽

National Level ◽

Direct Consequence ◽

Hospital Ward ◽

Model Parameters ◽

Capacity Model ◽

New Variant ◽

Pessimistic Scenario ◽

Demand And Capacity ◽

Excess Deaths

Abstract Background This paper describes a model for estimating COVID-19 related excess deaths that are a direct consequence of insufficient hospital ward bed and intensive care unit (ICU) capacity. Methods Compartmental models were used to estimate deaths under different combinations of ICU and ward care required and received in England up to late April 2021. Model parameters were sourced from publicly available government information and organisations collating COVID-19 data. A sub-model was used to estimate the mortality scalars that represent increased mortality due to insufficient ICU or general ward bed capacity. Three illustrative scenarios for admissions numbers, ‘Optimistic’, ‘Middling’ and ‘Pessimistic’, were modelled and compared with the subsequent observations to the 3rd February. Results The key output was the demand and capacity model described. There were no excess deaths from a lack of capacity in the ‘Optimistic’ scenario. Several of the ‘Middling’ scenario applications resulted in excess deaths—up to 597 deaths (0.6% increase) with a 20% reduction compared to best estimate ICU capacity. All the ‘Pessimistic’ scenario applications resulted in excess deaths, ranging from 49,178 (17.0% increase) for a 20% increase in ward bed availability, to 103,735 (35.8% increase) for a 20% shortfall in ward bed availability. These scenarios took no account of the emergence of the new, more transmissible, variant of concern (b.1.1.7). Conclusions Mortality is increased when hospital demand exceeds available capacity. No excess deaths from breaching capacity would be expected under the ‘Optimistic’ scenario. The ‘Middling’ scenario could result in some excess deaths—up to a 0.7% increase relative to the total number of deaths. The ‘Pessimistic’ scenario would have resulted in significant excess deaths. Our sensitivity analysis indicated a range between 49,178 (17% increase) and 103,735 (35.8% increase). Given the new variant, the pessimistic scenario appeared increasingly likely and could have resulted in a substantial increase in the number of COVID-19 deaths. In the event, it would appear that capacity was not breached at any stage at a national level with no excess deaths. it will remain unclear if minor local capacity breaches resulted in any small number of excess deaths.

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Excess deaths associated with the Iranian COVID-19 epidemic: A province-level analysis

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2021.04.015 ◽

2021 ◽

Author(s):

Mahan Ghafari ◽

Alireza Kadivar ◽

Aris Katzourakis

Keyword(s):

Province Level ◽

Level Analysis ◽

Excess Deaths

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Years of life lost to COVID-19 in 81 countries

Scientific Reports ◽

10.1038/s41598-021-83040-3 ◽

2021 ◽

Vol 11 (1) ◽

Cited By ~ 6

Author(s):

Héctor Pifarré i Arolas ◽

Enrique Acosta ◽

Guillem López-Casasnovas ◽

Adeline Lo ◽

Catia Nicodemo ◽

...

Keyword(s):

Seasonal Influenza ◽

The Elderly ◽

Years Of Life Lost ◽

Life Years ◽

The Dead ◽

Excess Deaths

AbstractUnderstanding the mortality impact of COVID-19 requires not only counting the dead, but analyzing how premature the deaths are. We calculate years of life lost (YLL) across 81 countries due to COVID-19 attributable deaths, and also conduct an analysis based on estimated excess deaths. We find that over 20.5 million years of life have been lost to COVID-19 globally. As of January 6, 2021, YLL in heavily affected countries are 2–9 times the average seasonal influenza; three quarters of the YLL result from deaths in ages below 75 and almost a third from deaths below 55; and men have lost 45% more life years than women. The results confirm the large mortality impact of COVID-19 among the elderly. They also call for heightened awareness in devising policies that protect vulnerable demographics losing the largest number of life-years.

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Forensic Pluralism and the Dead Body in Early 20th-Century China

Academic Forensic Pathology ◽

10.1177/19253621211002504 ◽

2021 ◽

pp. 192536212110025

Author(s):

Daniel Asen

Keyword(s):

20Th Century ◽

Forensic Medicine ◽

First Generation ◽

Early 20Th Century ◽

13Th Century ◽

The Qing Dynasty ◽

Forensic Practice ◽

Local Officials ◽

Examination Methods ◽

Death Investigation

Modern forensic medicine was introduced into China during the first decades of the 20th century. The members of China’s first generation of medicolegal experts were soon advocating that medical expertise play a greater role in police and judicial officials’ investigations of suspicious death and homicide cases. While forensic reform in China had parallels with developments in other contemporary societies in which physicians were pushing for a greater role in the law, this process unfolded in China in unique ways, against the backdrop of an older tradition of forensic science that had developed under the Qing dynasty (1644-1911). Central to this tradition was the Records on the Washing Away of Wrongs, a handbook of forensic practice that was written in the 13th century and saw numerous editions and expansions over subsequent centuries. Death investigation in early 20th-century China was defined by “forensic pluralism,” a situation in which the different body examination methods and standards of forensic proof associated with the Washing Away of Wrongs and modern forensic medicine were both accepted by officialdom and society. This article untangles the complexities of forensic practice during this period through the rather unexceptional exchange over a case of suspected drowning that occurred between local officials in Hebei province and Lin Ji (1897-1951), director of the Beiping University Medical School Institute of Legal Medicine. This case reveals the different regimes of forensic knowledge and practice that were used in China during this period as well as the sites at which they interacted.

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