Importance of prepositions when talking about Covid

Shashi Tharoor

As the COVID-19 pandemic persists around the world there’s a grim distinction that doctors, linguists and statisticians are all debating. It has to do with prepositions. What’s the difference between dying “of” COVID-19 and dying “with” COVID-19? The world is full of cases in the last two years where people suffering from serious ailments like advanced cancer or heart disease (or even simply what are often called “old-age ailments”) also contracted COVID-19, struggled to breathe, and passed away.

Some medical systems record their passing as caused by COVID-19, on the grounds that while they may have been weakened by their underlying disease, death was undoubtedly accelerated and precipitated by COVID-19. Other places go the other way, recording that the patient succumbed to the cancer or to a heart complication, rather than to COVID-19. The first implies dying “of” COVID-19 and the second dying “with” COVID-19. This is not a trivial distinction. It affects local, national and global health statistics, which in turn influence the allocation of resources; lockdown policies and similar restraints that affect people’s lives and paralyse economies; public health measures to battle the disease; the willingness of people to travel to such areas; and, in countries like India, compensation to the families of people who have died from COVID-19.

Official government figures are based on such prepositions. But the fundamental question is of course a medical, not a linguistic one: What defines a COVID-19 death?

But it’s also true that COVID-19 kills in various ways, and an infection can worsen existing afflictions. COVID-19, doctors tell us, can cause pneumonia and respiratory failure, but also cause blood clots, strokes and heart attacks, as well as render patients vulnerable to other fatal illnesses, such as septic shock or the notorious “black fungus” that took many lives last year in India.

Many COVID-19 patients have died from multiple causes, rather than just one thing. COVID-19 can often complicate a patient’s recovery from other diseases and conditions—even unrelated injuries— and indirectly contribute to their death. The virus’s impact on people with existing medical conditions— such as diabetes, hypertension, and heart ailments—can make COVID-19 one of several contributors to a death.

Some have even died because of, during or after botched medical procedures to deal with some aspect of their condition. When elderly people in advanced physical and mental decline due to Alzheimer’s disease and atrial fibrillation contract COVID-19, they die sooner than they might otherwise have.

Did they die of COVID-19, if the illness merely accelerated their death from other causes? But what do you do if someone had COVID-19, but had recovered from the coronavirus when they died of something else? Or if COVID-19 wasn’t diagnosed, or if the person had no symptoms when he died of something else? Unless a post-mortem establishes COVID-19, you might never know – and you won’t officially declare – whether the person died of or with the disease.

Then there are those who died from other causes as a result of avoiding medical care because of the pandemic. Should we say they died from the disease but not of or with it? But in many places, counting people who died of COVID-19 and with COVID-19 as the same thing, led to a public outcry of exaggeration—which prompted some in the US to change how they reported coronavirus deaths.

After all, high numbers can generate what I call “Coviphobia”, which I define as an exaggerated fear of catching the coronavirus. All this proves that language is no small matter. It’s vital to differentiate between people who died of or from COVID-19 and people who died with COVID-19. If the difference between “of” and “with” is so vital in determining the death rate from the virus, we should all mind our prepositions!

(Dr Shashi Tharoor is a third-term MP for Thiruvananthapuram and award-winning author. The article originally appeared in The Quint)