Dear Editor,
We would like to share ideas on the report “No evidence of substantial underreporting of COVID-19 deaths in Taiwan during 2020.1” Chen et al. noted that “It is important to continue monitoring monthly/weekly excess and cause-specific mortality as the COVID-19 pandemic progresses.1” We agree that it is important to assess underreporting of COVID-19 deaths. The modelling technique proposed by Chen et al. might be helpful for similar assessment in other settings. However, we would like to point out some important facts. First, if there is no COVID-19 test for all deaths, the missed diagnosis of asymptomatic or undiagnosed COVID-19 is possible. Indeed, the problem of lack of COVID-19 test in forensic examination has been raised since early outbreak of disease.2 Second, the chance of false negative remains in case that there is a post mortem COVID-19 test. It is necessary to account for effect of false negative in assessment of possible Underreporting of COVID-19 deaths. Additionally, a case with a confirmed cause of death might have a hidden COVID-19.
Declaration of competing interest
The authors have no conflicts of interest relevant to this article.
References
- 1.Chen E.Y., Sachs M.C., Dickman P.W. No evidence of substantial underreporting of COVID-19 deaths in Taiwan during 2020. J Formos Med Assoc. 2021 Sep;120(9):1788–1789. doi: 10.1016/j.jfma.2021.03.018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Sriwijitalai W., Wiwanitkit V. COVID-19 in forensic medicine unit personnel: observation from Thailand. J Forensic Leg Med. 2020 May;72:101964. doi: 10.1016/j.jflm.2020.101964. [DOI] [PMC free article] [PubMed] [Google Scholar]