November 07, 2026

If Covid-19 Strikes, Comorbidity Should Not Count

By Sunil Garodia
First publised on 2020-04-26 20:30:00

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Editor-in-Chief of indiacommentary.com. Current Affairs analyst and political commentator. Author of Cyber Scams in India, Digital Arrest, The Money Trap and The Human Hack

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There is a lot of confusion in the time of the current pandemic about whether deaths are due to Covid-19 or comorbidity. To clear the confusion, the term comorbidity has to be understood in precise terms. Comorbidity is said to be the presence of one or more additional conditions co-occurring with (that is, concomitant or concurrent with) a primary condition. For instance, if the patient's primary condition is diabetes his or her comorbid conditions can include high blood pressure, high cholesterol, high triglycerides, obesity and other conditions. If he or she dies due to any of the comorbid conditions, then he or she could be said to have died of comorbidity.

But there is one thing that we need to demark in this. If the existing diseases of patients are in control and they are taking usual medications for the same and are in their normal condition, then if they are stricken with Covid-19 or any other infection or disease that worsens their condition and results in death, then they will be said to have died of that infection. For, Covid-19 is not a concurrent or concomitant condition. It is a new infection that was not in any way connected or present or even had the chance of being activated in his or her body. It struck from outside and has to be acknowledged as such.

The primary differentiator here is the chance of living. If the person's existing diseases were not fatal and if he was leading a normal life - of course with medication for his or her existing diseases - he or she would not have died, say in a few days or months, due to his current condition. If Covid-19 strikes such a person and if his or her condition worsens - for instance, if his organs start failing - then the trigger was Covid-19. So, in such cases, it is clear that Covid-19 killed him or her.

The World Health Organization (WHO) has clear guidelines in this regard. It says that "a death due to COVID-19 is defined for surveillance purposes as a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma). There should be no period of complete recovery from COVID-19 between illness and death. A death due to COVID-19 may not be attributed to another disease (e.g. cancer) and should be counted independently of preexisting conditions that are suspected of triggering a severe course of COVID-19".

While talking of comorbidities, the WHO says that "there is increasing evidence that people with existing chronic conditions or compromised immune systems due to disability are at higher risk of death due to COVID-19. Chronic conditions may be non-communicable diseases such as coronary artery disease, chronic obstructive pulmonary disease (COPD), and diabetes or disabilities. If the decedent had existing chronic conditions, such as these, they should be reported in Part 2 of the medical certificate of cause of death." It clearly means that the underlying cause of death should be mentioned as by Covid-19 and comorbid conditions should be mentioned as "other significant conditions contributing to death".

In any case, should we be fighting over numbers or technicalities in the pandemic? Now, the clear logic should be that if a person is infected with Covid-19 and if he or she dies, then death must be acknowledged as a Covid-19 death. Only then will we have the correct figures of how many were infected, how many cured and how many died. Hence, the talk of death by comorbidity in the times of the pandemic is confusing and misleading.