Michael Fitzmaurice (Roscommon-Galway, Independent)
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696. To ask the Minister for Health the reason the statistics of his Department on the cause of death in Ireland in the time period March to November 2020 are different to those of the CSO; and if he will make a statement on the matter. [39909/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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On 25 November 2020 the Central Statistics Office (CSO) published the ‘Analysis of Underlying Cause of Death Data, Including COVID-19 report ‘as a new publication in their frontier series. ()

This publication is based on deaths registered with the General Registrar’s Office (GRO) and notified to the CSO for the period of January to October 2020.

The findings of the CSO publication reported that there were 1,462 Covid-19 related deaths in the period January – October 2020 registered with the General Registrar's Office and subsequently notified to the CSO.

As of the 1^stof November, the Department of Health had been notified of 1,915 Covid-19 related deaths. This is 453 higher than reported by the CSO for deaths registered by the end of October.

These deaths have been reported to the Department of Health by the Health Protection Surveillance Centre (HPSC). Under Infectious Diseases (Amendment) Regulations 2020, all medical practitioners are required to notify the Medical Officer of Health (MOH)/Director of Public Health (DPH) of certain diseases including Covid-19.

There are several reasons for the difference in these figures:

a. The CSO note that the data in their publication is based on deaths that occurred between 1 Jan 2020 and end October 2020, and that have been registered with the General Registrar's Office and subsequently notified to the Central Statistics Office (CSO). They also note that these figures are provisional.

b. Due to the legal requirement for registration of deaths being within 3 months in Ireland, it can be assumed that deaths for the months August-October registered with the GRO and subsequently notified to the CSO are incomplete.

c. Outside of these months, there are a significant proportion of deaths that are registered after 3 months. The most common reason for a late registration of a death is that a case is referred to the Coroner for further investigation.

d. All unnatural deaths (deaths from accidents, suicides, poisonings etc.) must be referred to the Coroner’s Office for further investigation and these deaths tend to be registered late as a consequence. In addition, all deaths that occur in nursing homes and all COVID-19 deaths must also be reported to the Coroner. The number of late registered deaths is increasing over recent years and the CSO publishes these late registered deaths as an appendix to the annual report.

e. The classification process for deaths related to COVID-19 differs between the HPSC and the CSO. Further detail is provided below on the process.

Further information:

Classification and publication of deaths by the HPSC:

A death reported by the by the Health Protection Surveillance (HPSC) as due to COVID-19 is defined for surveillance purposes as a death resulting from a clinically compatible illness, in a possible, probable or confirmed COVID-19 case as per the case definition for COVID-19, available on the HPSC website www.hpsc.ie, unless there is a clear alternative cause of death that cannot be related to COVID-19 disease (e.g. trauma). There should be no period of complete recovery from COVID-19 between illness and death. A death due to COVID-19 may not be attributed to another disease (e.g. cancer) and should be counted independently of pre-existing conditions that are suspected of triggering a severe course of COVID-19.

HPSC Procedure for recording and checking COVID-19 deaths

All medical practitioners and coroners have been advised to report all deaths in confirmed, probable and possible COVID-19 cases, in any healthcare setting, to their local Department of Public Health and these are notified to the HPSC.

The case definitions for confirmed, probable and possible COVID-19 are available on the HPSC website. The outcome for cases that have already been notified is then updated to ‘died’ on HPSC’s Computerised Infectious Disease Reporting System (CIDR) and cases newly identified on death are notified.

The following deaths should be notified as COVID-19 deaths:

- Deaths in confirmed COVID-19 case: A death in a person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms (including post mortem).

- Deaths in probable COVID-19 case: A death in a person with probable COVID-19 as per the COVID-19 case definition for surveillance purposes

- Deaths in possible/suspect COVID-19 case: All deaths in patients suspected of having COVID-19 i.e. patients with symptoms clinically compatible with COVID-19 illness. These suspect cases may or may not have been laboratory tested for COVID-19 prior to death. These possible COVID-19 deaths include patients with pending COVID-19 laboratory results. This includes all unexplained deaths/sudden deaths in residential facilities with a confirmed/suspected COVID-19 cluster/outbreak of illness unless the there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma)

- Coroner’s reports of deaths: All COVID-19 deaths reported as such from Coroners should be notified as COVID-19 deaths. The case classification should be assigned as per the COVID-19 case definition.

The HPSC also receives a daily list of deaths from all causes which were registered in Ireland in the previous day from the General Register Office (GRO). All registered deaths with COVID-19 reported in any of the four cause of death fields are reported as COVID-19 deaths. The causes of death on the GRO file are checked for ‘COVID-19’ and cross-checked against the details for the cases of COVID-19 notified to HPSC.

Deaths in patients with COVID-19 due to causes such as accidents, trauma or other causes that could not be related to COVID-19 are recorded as not due to COVID-19. Deaths in COVID-19 cases occurring more than 30 days after the COVID-19 diagnosis are flagged and checked to ascertain if the death should be reported as due to COVID-19 or not due to COVID-19. If there is a period of complete recovery between the COVID-19 related illness and death, the deaths are recorded as not due to COVID-19.

HPSC publications on COVID-19 related deaths

Publication of COVID-19 Related deaths by the HPSC are made on a daily basis on the HPSC website, based on the data held in CIDR at that time. CIDR is a live dataset and data is subject to revision when new information is received.

Classification of COVID-19 related deaths by the CSO:

The CSO classify the information received from the General register Office on the Death Certificate to assign an Underlying Cause of Death (UCOD). This is a complex process as coding rules that are adopted by the World Health Organisation (WHO) are applied to ensure parity between jurisdictions.

CSO Procedure for recording and checking COVID-19 deaths

It is a legal requirement that every death that takes place in the State must be recorded and registered and these records are then held in the General Register Office (GRO). A death within the State can be registered with any Registrar, regardless of where it occurs. Deaths must be registered as soon as possible after the death and no later than three months from the date of death.

Following a death, a registered medical practitioner who attended the deceased will complete and sign Part 1 of a Death Notification Form (DNF), and this will include information on the cause of death.

This form is then given to the spouse/partner or another relative of the deceased who are then the qualified informant for the death. If the deceased has no spouse/partner or other relative, then the form will be provided to another qualified informant.

The qualified informant must then complete Part 2 of this DNF with additional details regarding the deceased person. Once completed, this DNF must then be given to a Registrar (within, as per the above, a maximum of three months) and the qualified informant then signs the register in the presence of the Registrar. You do not need to be the next-of-kin to undertake this requirement.

The Cause of Death is completed by the medical practitioner who attended the deceased and has the following information:

Part 1(a): Disease or condition directly leading to death, (this does not mean the mode of dying e.g. heart failure etc., it means the disease that caused death) due to (or as consequence of)

Part 1(b): Antecedent Causes (morbid conditions, if any, giving rise to the above cause stating the underlying condition last) due to (or as consequence of)

Part 1(c): Further Antecedent Causes

Part 2: Other Significant Conditions (contributing to the death but not related to the disease or condition causing it)

Any death that occurs in the State must be registered in the State, e.g. a death of a US resident holidaying in Ireland must be registered here. An Irish national that dies abroad is not registered in the State.

The registration of a death may be delayed where the death has been referred to a Coroner for investigation or inquiry. In such cases, the Coroner may issue a temporary certification to allow the death to be registered pending final determination of any investigation or inquiry.

CSO Mortality Coders in the Vital Statistics unit use specialised software (IRIS) and defined coding rules on the specified causes of death to assign an appropriate underlying cause of death. The hierarchy in which the causes are written on the death certificate impacts on the assignment of the UCOD. According to the WHO international guidelines, persons with COVID-19 may die due to other conditions such as myocardial infarction.

CSO publications on COVID-19 related deaths;

The ‘Frontier Series’ that this data was published under is a new development from the CSO. The CSO Frontier Series may use new methods which are under development and / or data sources which may be incomplete for example new administrative data sources which may have specific limitations.

The CSO publishes quarterly deaths data together with a summary of the four quarters (when publishing Quarter 4) classified by year of registration. It also publishes annual statistics on deaths by year of occurrence, with a time lag of approximately 22 months.

The CSO published the Vital Statistics Quarter 2 data on 27th November 2020. The CSO will report data for Quarter 3 next year based on the registration data compiled from the General Register Office.

The CSO also releases the “COVID-19 Deaths and Cases Statistics” publication on its website in its fortnightly publication. This publication is based on the HPSC CIDR data extract.

This publication is available at 19informationhub/health/covid-19deathsandcasesstatistics/

Michael Fitzmaurice (Roscommon-Galway, Independent)
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697. To ask the Minister for Health the criteria the death of a person must meet for the cause of death to be recorded as Covid-19 despite the person having other underlying health issues; and if he will make a statement on the matter. [39910/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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Since the National Public Health Emergency Team (NPHET) met for the first time, a commitment was given to collect and publish as much relevant data as possible while ensuring individual patient confidentiality is maintained at all times. While the nature and scale of the COVID-19 pandemic has been unprecedented, the collection of timely and comprehensive data has been instrumental in developing the health service response to Covid-19 and to the advice provided by the NPHET and the Department of Health to assist Government decision-making in the wider response to the disease in Ireland.

It should be noted that in Ireland, data are collected on COVID-19 related mortality for both lab confirmed and probable cases, in line with recommendations from the World Health Organisation and the European Centre for Disease Prevention and Control in both hospitals and the community. It should also be noted that collection of COVID-19 related mortality data in Ireland exceeds that of many other countries in the world.

The Deputy should note that comprehensive national statistics, information, and data about Covid-19 is published on a daily basis on the Department of Health website at and on the Covid-19 Data Hub and Dashboards available at . The published data are based on official figures provided by the Health Protection Surveillance Centre (HPSC) and the Health Service Executive (HSE). All datasets, charts and maps are updated on an on-going basis and in line with newly published data.

I would also direct the Deputy to the CSO website for access to a range of data relating to Covid-19 including the numbers of diagnosed cases and mortality data. This is available on the CSO Covid-19 Information Hub at and, in particular, at

You may also wish to note that a range of data on the epidemiology of Covid-19 in Ireland is published in the daily report by the Health Protection Surveillance Centre (HPSC) available at: www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/casesinireland/epidemiologyofcovid-19inireland, while a daily report on the last 14 days in cases available at: www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/casesinireland/epidemiologyofcovid-19inireland.

As this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.

Michael Fitzmaurice (Roscommon-Galway, Independent)
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698. To ask the Minister for Health the number outbreaks of Covid-19 that have been identified as a direct result of gatherings in wet pubs; and if he will make a statement on the matter. [39911/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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The Government’s medium-term strategy, Resilience and Recovery 2020-2021: Plan for Living with COVID-19, sets out Ireland's approach to managing and living with COVID-19 in a range of areas over a period of 6 - 9 months.

This 5 level Framework reflects a careful consideration of the impact of the introduction of restrictions on employment and livelihoods, keeping as many businesses open as possible at different stages, while acknowledging that some businesses and services are critical. It acknowledges that pubs and the hospitality sector are the world of work for so many in our communities.

As I'm sure you can appreciate, COVID-19 spreads when individuals and groups come into close contact with one another, enabling the virus to move from one person to another. COVID-19 is infectious in a person with no symptoms, or for the period of time before they develop symptoms. The number of people allowed to gather in different scenarios in the Government's Framework are based on a review of international practice and the judgment of public health experts. It seeks to balance the risks of different types of gatherings against the desire to allow normal activities to proceed in so far as possible. The Government is committed to ensuring a balanced and proportionate response to COVID-19 by finding ways to implement public health measures in response to the pandemic in a way that is fair, reasonable and proportionate.

I would like to assure you that measures such as this are aimed at limiting the spread and damage of COVID-19, and are necessary to protect our key priorities of supporting and maintaining health and social care services, keeping education and childcare services open and protecting the most vulnerable members of our communities.

You may wish to note that the Health Information Quality Authority (HIQA) has recently published its advice for the National Public Health Emergency Team (NPHET) on the settings and activities which are associated with a higher risk of COVID-19 transmission. The publication of this advice is accompanied by a supporting evidence synthesis report which examined data from international sources and found that indoor, high occupancy, poorly ventilated environments, where there is shouting and singing, insufficient use of face coverings, and prolonged contact, present an increased risk of SARS-CoV-2 transmission. These findings support the NPHET’s current stance on settings, such as pubs, and activities such as drinking, which present a higher risk of transmission of Covid-19. HIQA's advice to the NPHET, Evidence Summary and supporting documentation is available at the following link:-

You may be interested to note that the Government also recently commissioned Ernst & Young to analyse and report on certain aggregated data as part of the Government's Covid-19 management strategy. This analysis has been published and is available at the following link:-

I would also draw your attention to the CSO website for access to a range of data relating to Covid-19 including data on confirmed COVID-19 cases linked to pubs and the hospitality sector. This is available on the CSO Covid-19 Information Hub at

www.cso.ie/en/releasesandpublications/ep/p-covid19/covid-19informationhub/ and, in particular, at

A range of data on the epidemiology of Covid-19 in Ireland, including data on trends in transmission, is also published in the daily report by the Health Protection Surveillance Centre (HPSC) available at:

www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/casesinireland/epidemiologyofcovid-19inireland, while a daily report on the last 14 days in cases available at: www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/casesinireland/epidemiologyofcovid-19inireland.

Further information on all levels of Resilience and Recovery 2020-2021: Plan for Living with COVID-19 is available at: