As it emerged that some of those who died at home alone of Covid-19 lay undiscovered for up to two weeks, one of the doctors who certified the deaths of people who died at home in London for the capital’s Pandemic Multi Agency Response Teams [PMART] explained the sad, challenging and mentally demanding nature of the work.
I was one of 30 doctors who at NHS England’s request volunteered to certify deaths of people who had died “in the community” – at home – rather than in a care home or hospital.
We were sent the deceased’s name, location of death and brief details of their medical history, which the ambulance service person or police officer had gathered. We then spoke to their GP, or hospital doctor, or relatives, to glean more information about them and what might have led to their death.
For about 10 days at the peak of the pandemic in April, PMART doctors issued about 60 to 80 death certificates a day for people who had died at home, and in the end we had issued one for about 700 people in all. We each certified about 20, 30 or 40 deaths. Of the ones I did, everyone who died was over 40, and most were over 70. Many had other diseases like diabetes, obesity, breathing problems or high blood pressure and a few had a history of drug or alcohol misuse. It was profoundly sad work, and challenging, but at the same time not grim work.
Most of us did a few cases in which people had died at home alone and lain undiscovered for some days. The longest time someone had gone before being discovered that I had was a week. Those cases were sad, especially given someone’s body had started to decompose. That made it impossible to say definitively if someone had died of Covid or something else, like a heart attack. However, we assumed that many were due to Covid, often exacerbated by underlying health problems.
So that I could do this work I struck a balance between caring and enabling myself to function. I approached it as a duty to carry out as a medical professional, rather than as a friend or relative, to minimise me getting distressed as a result of feeling empathy for the deceased and their family, as that would inhibit your ability to do your job. And it helped that we did this work remotely, often from our own homes. We then passed on our findings to either the local coroner or local registrar of deaths. I suspect we will hear more about these tragic deaths of people alone at home when coroners’ inquests begin.
