Dying “from” or “with” covid-19 during the pandemic: Medico-legal issues according to a population perspective

Fabio De-Giorgio, Vincenzo M. Grassi, Eva Bergamin, Alessandro Cina, Franca Del Nonno, Daniele Colombo, Roberta Nardacci, Laura Falasca, Celeste Conte, Ernesto D’aloja, Gianfranco Damiani, Giuseppe Vetrugno

Research output: Contribution to journalArticlepeer-review


There is still a lack of knowledge concerning the pathophysiology of death among COVID-19-deceased patients, and the question of whether a patient has died with or due to COVID-19 is still very much debated. In Italy, all deaths of patients who tested positive for SARS-CoV-2 are defined as COVID-19-related, without considering pre-existing diseases that may either contribute to or even cause death. Our study included nine subjects from two different nursing homes (Cases 1–4, Group A; Cases 5–9, Group B). The latter included patients who presumably died from CO poisoning due to a heating system malfunction. All subjects tested positive for COVID-19 both ante-and post-mortem and were examined using post-mortem computed tomography prior to autopsy. COVID-19 was determined to be a contributing cause in the deaths of four out of nine subjects (death due to COVID-19; i.e., pneumonia and sudden cardiac death). In the other five cases, for which CO poisoning was identified as the cause of death, the infection presumably had no role in exitus (death with COVID-19). In our attempt to classify our patients as dying with or due to COVID-19, we found the use of complete assessments (both histological analyses and computed tomography examination) fundamental.

Original languageEnglish
Article number8851
Pages (from-to)1-13
Number of pages13
JournalInternational Journal of Environmental Research and Public Health
Issue number16
Publication statusPublished - Aug 2 2021


  • Causality
  • CO intoxication
  • COVID-19
  • Pneumonia, post-mortem computed tomography
  • Post-mortem computed tomography

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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