In 45 years of practicing medicine, I have completed hundreds of death certificates, if not thousands.

Once, a public employee told me that she had chosen me as her doctor because I had had fewer death certificates cross her desk than any orther doctor. She added that from the time she made her decision to her first appointment, I had the most.  She laughed.

The point is that any doctor will tell you that it is not always easy to establish the primary cause of death without an autopsy.

For instance, if a patient has lung cancer and dies in a car wreck, what would you state as the cause of death?  Likewise, if a person tests positive for coronavirus and dies of a stroke, what is the cause of death?

Obviously, a death certificate allows and requires the designation of the “cause of death;” the condition which resulted in demise and the documentation of Rotherham or secondary conditions.

Before the information in this report is helpful for public health or epidemiology, we have to know whether the coronavirus infection is the primary and proximal cause of death, or whether it is a coincident condition but one which was not the immediate cause of death.