A coronial investigation is under way into the cause of death of a COVID-19-positive Victorian man in his 20s widely reported to be the youngest Australian to succumb to the virus.
The review into the man's cause of death has raised important questions about how Australia classifies coronavirus fatalities and comes as 113 new infections were recorded in Victoria in the past day.
The coronavirus that causes COVID-19. Credit:AP
The state's death toll climbed to 496, with 12 more deaths, all linked to aged care outbreaks.
Almost two weeks after the young's man death was reported on August 14, it is yet to be included in the national coronavirus fatalities tally.
At the time of the man's death, Premier Daniel Andrews would not speculate on whether the man died of or with coronavirus, but he floated the prospect that the Victorian coroner may investigate it.
The state's public health team confirmed on Friday a coronial review into his death was under way.
Experts warn the true extent to which coronavirus is causing death in Australia may not be known for at least another year.
In Australian states and territories, like countries across the world, the COVID-19 death figures being reported daily are hospital cases where a person dies with the coronavirus infection in their body given it is a notifiable disease in which all cases must be reported.
SARS-CoV-2, the virus which causes COVID-19, could be the major cause of death, a contributory factor or simply an infection present when a person dies of another medical condition.
"It's very complex," says leading infectious diseases physician Professor Peter Collignon from the Australian National University.
"Realistically, what we need is good data analysing the number of people who have died with COVID. We know that coronavirus is undoubtedly contributing to their death, but is it a 10 per cent contribution, a 90 per cent contribution or 100 per cent compared to their underlying disease? We can't say that with any accuracy yet."
Gathering this detailed data would take months, or even years, Professor Collignon said.
As Australia still has a relatively low death toll compared to places like the United States, the United Kingdom and Europe, much of this analysis is likely to be undertaken in countries with robust healthcare systems where fatalities still soared into the thousands.
"In the short term, I think what they are doing in Australia is entirely sensible because we need clear and immediate surveillance on the number and age of people dying with the virus," Professor Collignon said.
"But in time, we need research on big samples of people who have died and look at, well, these people died with COVID, but they also had cancer, or they had heart disease or diabetes, so what was the relative contribution of coronavirus to their death? That's the sort of finessing you need with time."
Questions have also been raised about discrepancies observed in Victorian and national coronavirus fatalities data.
Victorian Chief Health Officer Brett Sutton said the state and federal governments were moving towards standardising how they classified deaths to ensure data aligned.
At the moment, if a case is notified as having died of other or unknown causes, but was coronavirus positive at the time of death, it is not included in federal government statistics.
This differs from Victoria, where any death of a person who is found to have died with COVID-19 is included in the tally.
Professor Sutton said the re-examination of cases could alter the state’s overall death toll.
“That might be an increase in some cases that hasn’t been reported to date, but also some that might be taken off the tally,” he said.
Professor Sutton stressed up to a third of elderly residents who had contracted coronavirus in Victorian aged homes had died so far.
"We do know that coronavirus is a very significant illness in the population and it is not unreasonable to classify those deaths as deaths from coronavirus when we understand that that wouldn't happen in a normal week," he said.
Professor Collignon said examining how deaths and illness from COVID-19 compared with the normal pattern of disease and deaths in Australia was also critical.
"There are many issues you need to look at particularly when you have a young person dying with COVID," Professor Collignon said. "You really want to learn more from those cases because they have a lot more implications for a bigger proportion of the population."
There are cases in Australia where people have died with no known health conditions. In another case, 30-year-old Queensland man Nathan Turner, who had underlying health conditions, was wrongly reported as Australia's youngest coronavirus victim in May.
Queensland Health later released a statement saying a false positive test was returned after his death and that he did not have the infection when he died.
Professor Sutton said the case numbers in Victoria were heading in the right direction and he expected the number of new daily cases could dip below 100 as soon as the weekend.
"It's not gotten below 100 yet, I do expect that to happen, if not over the weekend, then by next week, if trends continue. We obviously have to hold the course here," he said.
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