Let’s have a look at another case scenario where COVID-19 is a contributing condition.

A 3-month-old male, presented with seizures to the hospital. He was admitted a month ago with ascites and renal failure and managed for severe acute malnutrition. A work-up for inborn error of metabolism was considered due to a family history of congenital nephrotic syndrome. During the previous admission, a syphilis (TPHA) test was negative, and Herpes simplex virus IgM result was equivocal. Urine protein:creatinine ratio indicated nephrotic range proteinurea. A coincidental SARS-CoV-2 swab sent on day 2 of admission was reported positive on the same day. He was transferred to COVID-19 ward in a stable condition but developed an acute aspiration event on the day of transfer. He was successfully resuscitated but died 2 days later from pneumonitis.

The immediate cause of death in this patient is

• Aspiration pneumonia, reported in Part 1 line a.
• Severe acute malnutrition due to Congenital nephrotic syndrome is reported as an intermediate cause in Part 1 line b.
• Congenital nephrotic syndrome is the underlying cause of death, so it is reported on the lowest used line of Part 1.
• COVID-19 may have contributed to the death but is not part of the causal sequence in Part 1. Thus, it is reported in Part 2 as a contributing condition.
Confirmed COVID-19 should be reported when laboratory confirmation of COVID is available.