In this next case scenario, a previously well 87-year-old female was admitted from a nursing home with 2 days’ history of severe respiratory distress. Multiple people at her nursing home had recently been diagnosed with COVID-19. She was evaluated in the emergency room as having Acute respiratory distress syndrome. Her chest X-ray revealed bilateral symmetrical infiltrates with lower zone predominance. She had profound hypoxia. At the time of admission, there was a severe shortage of available ventilators, and she was not thought to be eligible for further escalation of care. She passed away in the emergency room within an hour of admission. No COVID test was performed.

The immediate cause of death in this patient is

• Acute respiratory distress syndrome, reported in Part 1, line a.
• COVID-19 is the probable underlying cause of death, so it is reported on the lowest used line of Part 1.
Suspected COVID-19 should be written on the death notification form when laboratory confirmation is not available.