COVID-19 Pandemic: Report of Coroner's Inquiries into Epidemiology and Total and Excess Mortality in the Community, Hospital and Nursing Home and Residential Care in the District of Kildare for the Year March 2020 to February 2021

All Covid-19 deaths, all nursing home and residential home deaths and deaths due to an adverse drug reaction must by law in Ireland be reported to the Coroner, the independent Judicial Officer of the State, in the District in which they occur. From 11th March 2020, when the first Covid-19 death occurred in Ireland, to 28th February 2021 there were 4,443 Covid-19 deaths nationally of which 230 (5%) were reported in Kildare with 163 (71%) of these deaths occurring in nursing and residential homes. The clinical epidemiology and documented excess mortality of the reported deaths are chronicled and analysed in this second report for three distinct periods of March to June 2020 (Period 1); July to December 2020 (Period 2); and January to February 2021 (Period 3) which also correspond with three “lockdown” periods, and for the consolidated “Covid-19 year” period from March 2020 to February 2021 (“the year”). These periods and annual figures are compared with the previous 5-year mortality figures noting that between 1st March 2015 and 28th February 2021 some 2,837 deaths were reported to the Coroner for the District of Kildare. The calculated excess number of deaths notified for March 2020 to February 2021 compared with 2015-2020 (5-yearly average of 567) was 300 (53%) of the 867 total deaths reported with a 169 (54%) excess in the 480 deaths in nursing and residential homes (5-yearly average of 311). Covid-19 deaths accounted for 77% of the total excess deaths and for 96% of the nursing and residential home excess deaths respectively. Following subtraction of the 66 non-natural cause deaths and 230 Covid-19 deaths from the total excess there remained an unexplained excess of 56 deaths due to natural causes in March 2020 to February 2021 compared with 2015-2021. Thus, the number of unattributed excess deaths actually fell marginally between July 2020 and February 2021 taking into account the figure of 62 in the first report for March to June 2020. Underlying medical conditions were recorded in all but two of those deaths related to Covid-19 and the average age of the deceased was 82.2 years with median age of 83 years and 58% were female (134) and 42% male (126). The numbers and percentages of Kildare Covid-19 cases out of the national cases were: 139 of 1,728 or 8% in Period 1; 26 of 575 or 5% in Period 2; 65 of 2,140 or 3% in Period 3; and 230 of 4,443 or 5% for the Covid-19 year. The excess total death percentage was 117%, 16%, 46% and 53% in the three periods and year respectively. In the nursing and residential home setting the corresponding numbers and percentages of Kildare cases out of the national cases were 113 of 985 or 11% (Period1); 9 of 175 or 4% (Period 2); 41of 668 or 6% (Period 3); and 163 of 1,828 or 9% for the Covid-19 year. The excess death percentages were 142%, 4% , 35% and 54% in the three periods and year respectively. Information analysed for this study allows Covid-19 public health policy and strategy to learn from mortality events and about the continuing challenges of the infection. The report is also set in the wider context of the Coroner Service and its role during the pandemic. The comments and observations are made on clinical epidemiology, co-morbidities, post mortem practices, bereavement, vaccination and the public health imperative for a centralized national mortality database and reformed death notification and certification systems for infectious disease surveillance. The tragic deaths in County Kildare of 230 individuals are best remembered and honoured by actions arising from that learning process to minimize the worst outcomes of any future similar infectious pandemic or if Covid-19 becomes a recurrent seasonal infection and some are recommended on foot of the findings and questions raised in this report. A legislative explanatory note is included at the end of the reference section.