The South East Regional Health Authority (SERHA) says there is a necessity to test deceased patients for COVID-19, to confirm the cause of death.

However, the Western Regional Health Authority (WRHA) doesn’t think this is necessary, considering the fact that patients are tested for the virus upon admission.

“It is mandatory that everybody who is hospitalised gets a COVID test, so we don’t have to test them after they die. It is mandatory that as you are admitted, you get a COVID test,” Dr Delroy Fray, clinical coordinator at the WRHA told the Jamaica Observer in a recent interview.

“We establish the diagnosis early, and even when a patient dies who was positive to COVID, we analyse it to see what is the cause of death. It is not every positive patient with COVID who dies, means it is a COVID death. You can have other co-morbidities that will cause your demise, and you have an incidental finding of being positive with COVID,” he added.

But Dr Sandra Chambers, regional technical director for the SERHA, told the Sunday Observer that patients are tested after they pass.

“We test them, especially if they arrive dead. We usually swab them to be sure what is happening. If you arrive and die shortly after arriving, you are swabbed,” she explained.

Chambers clarified, however, that if this is done religiously, it is definitely done for the most part.

“There might be a one-off when it is not done depending on what is happening, but usually, we do, especially if we are not sure what is happening. We want to know what is happening. Anything suspicious, we swab. Suspicious history, we swab. That’s the only way we are going to know. And of course, it is resource dependent. As long as we have the resource at hand, we will do it and we have not really been out of resources.”

The Centers for Disease Control and Prevention (CDC) recommends that if post-mortem nasopharyngeal (NP) swabs are being collected from a person with confirmed or suspected COVID-19, only those personnel who are obtaining the specimen should be in the room.

For suspected COVID-19 cases, the CDC recommends collecting and testing post-mortem NP swabs, and if an autopsy is performed, lower respiratory specimens (lung swabs). If the diagnosis of COVID-19 was established before death, the CDC says collection of these specimens for COVID-19 testing may not be necessary and that medical examiners, coroners, and pathologists should work with public health or clinical laboratories to determine capacity for testing post-mortem swab specimens.

Fray contended that the WRHA doesn’t need to test the deceased to be sure if a death was caused by COVID-19.

“That is why sometimes the Ministry of Health gives a report about COVID deaths, they will say some are under investigation, which means we would want to look at those deaths in a little more detail to see what is the cause of death… to see if it is related to COVID, or if COVID is an incidental finding in the situation that the patient has,” he said.

Chief executive officer of the University Hospital of the West Indies (UHWI) Kevin Allen agreed. Allen told the Sunday Observer that testing every patient who dies would put a strain on resources.

“If you tested negative and then go into the general population and you transition for whatever reason, we don’t do another test to find out whether or not it’s COVID. Remember we can’t burden the resources like that in any case, so what we do is that we do the antigen test for initial management and then the PCR test (polymerase chain reaction). So, we make sure we have double negative or double positive and then we proceed with the management of the patient,” he said.

“It’s not every death here that is COVID. Those persons who are on the COVID ward, the doctors would carry out the necessary examinations and stuff to confirm cause of death. But if you are ill on a general ward, and you have been tested already for COVID and you transition, we wouldn’t test you again. We have separate populations running simultaneously, so once you have been cleared for no COVID, if you transition, we wouldn’t test you again for COVID.”

Allen added: “That is how we manage it. We run two parallel systems. So, upon entry into the emergency room, no patient is admitted unless we know your COVID status. If you come in with a broken arm, that’s a surgical procedure there, but we still test you for COVID before you’re transferred to the general hospital population.”

Meanwhile, Opposition spokesperson on Health and Wellness, Dr Morais Guy said if hospitals were testing the deceased for the virus before, it is only fitting for them to continue.

“I don’t think we have so many people dying that the resources of the State could not be utilised by testing to determine the cause of death. I would be for a situation where people know what caused someone to die. It might be coincidental in some instances that a person had COVID and died, which is why the ministry gives coincidental deaths in their reporting.

“There are three categories: deaths, deaths under investigation and coincidental deaths. Whichever category these people fall in, it would give us a better picture of the extent of the spread of the infection in the country. In respect of that, if the authorities have been doing that before, then I see no reason for them to discontinue.”