In this next case scenario, a 3-week-old male neonate presented with acute gastroenteritis and severe dehydration. He was delivered at term via normal vaginal delivery with Apgars of 9 and 10. He went into progressive respiratory distress on day 2 of admission and was intubated and placed on ventilation and inotropic support. COVID-19 swab was done, and the result was positive. CXR revealed bilateral infiltrates; arterial blood gas analysis was indicative of Acute respiratory distress syndrome.

Both parents were referred for COVID-19 testing and were confirmed positive for SARS-CoV-2. He remained in ICU for more than a week and was put on antibiotics for suspected nosocomial sepsis. However, his condition worsened, and he died on day 18 of admission.

The immediate cause of death in this patient is

• Acute respiratory distress syndrome, reported in Part 1, line a.
• COVID-19 is the underlying cause of death, so it is reported on the lowest used line of Part 1.
Confirmed COVID-19 should be reported on the death notification form when laboratory confirmation is available.

• Nosocomial sepsis could 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.