HNZ00034470 Response.pdf

28 February 2024
K Thompson
[FYI request #25142 email]
Tēnā koe
Your request for official information, reference: HNZ00034470
Thank you for your email on 12 December 2023, asking Health New Zealand | Te Whatu Ora for the
following under the Official Information Act 1982 (the Act):
Thank your for your OIA response HNZ00031073 relating to Covid deaths.
Are you referring in this answer to Covid deaths in the first wave of Covid (delta variant) only, or to
deaths in the first and second waves (delta and omicron)?  Are these categories of death what you
use now?
In response to my question: "What is the difference between "Covid-19 as underlying" and "Covid-
19 as contributory"?
You said regarding the category "underlying cause of death":
"An underlying cause of death is defined as the disease or condition that initiated the train of events
leading directly to death".
With Covid, what are the "trains of events" that lead to death? (eg cough, shortness of breath, etc).
In other words, by what physical mechanisms does Covid cause death?
What are the hospital treatments for people with Covid "as an underlying cause", that is, presumably,
when Covid is their main or only illness?
Have hospital treatments improved for Covid?  What things work and what don't?  Have any lessons
been learned regarding treatment?  Is keeping warm important, since Covid is a type of cold or flu?
You said regarding "contributory cause of death":
"A  contributory  cause  of  death  is  any  cause  of  death  that  is  neither  the  immediate,  intervening,
originating  antecedent  nor  underlying  cause;  hence  there  are  other  significant  conditions  that
contributed to the fatal outcome, but were not related to the disease or condition directly causing
death."
Please can you outline the "immediate, intervening, originating antecedent and underlying" or direct
causes of death for people listed as having Covid as contributory to their deaths.
That is, what are or were their main causes of death, eg cancer, heart conditions, stroke, aneurysm,
collapse and so on?
What percentage of people die with Covid as "underlying" and what percentage die with Covid as
"contributory?

Response
For the sake of clarity, I will answer each question in turn.
Are you referring in this [HNZ00031073] answer to Covid deaths in the first wave of Covid
(delta variant) only, or to deaths in the first and second waves (delta and omicron)?  Are these
categories of death what you use now?
The previous response  was related to  all “waves” of COVID-19. However, over the course of the
pandemic, the main metric tracking COVID-19 deaths has shifted from deaths ‘with COVID-19’ to
deaths ‘from COVID-19’. The change in death reporting occurred in mid-2022 and has not changed
since.
You can find the current guidelines around certifying cause of death for COVID-19 related deaths
can  be  found  at  www.tewhatuora.govt.nz/for-the-health-sector/health-sector-guidance/burial-and-
cremation-act-1964/completing-death-documents/covid-19-deaths/
With Covid, what are the "trains of events" that lead to death? (eg cough, shortness of breath,
etc).  In other words, by what physical mechanisms does Covid cause death?
What  are  the  hospital  treatments  for  people  with  Covid  "as  an  underlying  cause",  that  is,
presumably, when Covid is their main or only illness?
Have hospital treatments improved for Covid?  What things work and what don't? Have any
lessons been learned regarding treatment?  Is keeping warm important, since Covid is a type
of cold or flu?
Information on these topics is publicly available at a wide range of sources. This includes clinical
information regarding the ways in which the COVID-19 virus can infect the human body and result
in severe health outcomes.
In particular, you may be interested in the COVID-19 Part of the Communicable Disease Manual,
available  at  www.tewhatuora.govt.nz/for-the-health-sector/health-sector-guidance/communicable-
disease-control-manual/covid-19/. It includes information on the disease, spread of infection, case
definition, and case management.
You can also find information on Clinical Management of COVID-19 in Hospitalised Adults on our at
www.tewhatuora.govt.nz/assets/For-the-health-sector/COVID-19-Information-for-health-
professionals/COVID-19-for-all-health-professionals/Clinical-Management-of-COVID-19-in-
Hospitalised-Adults.pdf.
It is important to note that these suggested resources are intended to guide health practitioners and
are just some of many. Further information on the topics can be found using the search function on
our website www.tewhatuora.govt.nz.
Please can you outline the "immediate, intervening, originating antecedent and underlying"
or direct causes of death for people listed as having Covid as contributory to their deaths.
That  is,  what  are  or  were  their  main  causes  of  death,  eg  cancer,  heart  conditions,  stroke,
aneurysm, collapse and so on?
This  part  of  your  request  is  refused  under  section  18(g)  of  the  Act  as  the  information  you  have
requested is not held by Health New Zealand | Te Whatu Ora and we have no grounds to believe
that the information is held by another entity subject to the Act.

Please  note  that  we  do  not  make  mortality  data  available  publicly  until  most  deaths  have  been
assigned a cause of death, so that the data released is complete and accurate. Currently, 2019 is
the most recent year for which cause of death data is available.
This is because after the close of a calendar year, there is a 12-18 months process to assign cause
of death codes to the majority of deaths in that year.  Our clinical coding team reviews the death
certificate  and  health  history  of  the  deceased,  to  assign  cause  of  death  codes.  However,
approximately  10%  of  deaths  are  referred  to  the  Coroner  each  year  to  determine  cause.  Deaths
which require a coronial inquiry can take 2-3 or more years for cause of death to be determined.
What  percentage  of  people  die  with  Covid  as  "underlying"  and  what  percentage  die  with
Covid as "contributory?
This  information  is  publicly  available  as  a  total  number  at  www.tewhatuora.govt.nz/our-health-
system/data-and-statistics/covid-19-data/covid-19-current-cases/#deaths-with-covid-19
How to get in touch
If you have any questions, you can contact us at [Health New Zealand request email].
If you are not happy with this response, you have the right to make a complaint to the Ombudsman.
Information about how to do this is available at Ombudsman New Zealand | Tari o te Kaitiaki Mana
Tangata or by phoning 0800 802 602.
As this information may be of interest to other members of the public, Te Whatu Ora may proactively
release a copy of this response on our website. All requester data, including your name and contact
details, will be removed prior to release.
Nāku iti noa, nā
Matt Hannant
Director
National Public Health Service
Health New Zealand | Te Whatu Ora
TeWhatuOra.govt.nz
Health NZ, PO Box 793,
Wellington 6140, New Zealand