Observe-up – Watts Up with that?

Guest News Letter from Kip Hansen – December 18, 2020

The New York Times and The Guardian both report a “landmark decision” from Great Britain. “A 9-year-old girl who suffered a fatal asthma attack in 2013 was the first person in the UK to have air pollution officially listed as a cause of death,” a UK official said. . . . In Wednesday’s ruling, London Assistant Coroner Philip Barlow said air pollution was a major contributor to both triggering and exacerbating Ella’s asthma, adding that she had been exposed to nitrogen dioxide and particulate levels that exceeded World Health Organization guidelines. ” [ source: NY Times ]

In a recent article here, I discussed the problems of reporting cause of death and some details of how it is done in the United States. For details, read (or read again) Cause of Death: A Primer.

The fact is that the cause of death is not simple, not dry, and not always obvious and often controversial. It is important to know that deaths are treated differently in the UK than in the US.

In the United States, a doctor or coroner simply fills out a death certificate detailing the chain of events or diseases that led to death, including any factors that contributed to it. In England and Wales there is a long list of cases where a fatality needs investigation. If you watch UK television broadcasts, you may be familiar with the older version of an investigation into which a coroner rules a death, natural death, suicide, homicide or “death by accident”.

The Guardian reports the case as follows:

A coroner made legal history by ruling that air pollution is a killer of a nine-year-old girl.

Philip Barlow, the coroner in south London, said Ella Kissi-Debrah’s death in February 2013 was due to acute respiratory failure, severe asthma and air pollution.

He said she was exposed to nitrogen dioxide and particulate matter pollution beyond the guidelines of the World Health Organization, the main source of which is traffic emissions.

The coroner said the failure to bring pollution to legal limits may have contributed to her death, as did the failure to provide her mother with information about the potential of air pollution to worsen asthma.

“Ella died of asthma caused by excessive air pollution,” the coroner said on Wednesday.

The death of this young girl had been the subject of an investigation in 2014 which found that she had died acute respiratory failure. But cause of death can be controversial and sometimes political. In this case:

Ella’s mother, Rosamund Kissi-Debrah, a former teacher, fought for years to have her daughter’s death examined by a second coroner. Her resilience was paid back on Wednesday when Barlow agreed with the family’s medical experts that Ella’s particular form of acute asthma was made worse by air pollution.

Kissi-Debrah’s lawyers stated that air pollution was a public health emergency and that it urgently needs to be recorded as a cause of death to ensure that public health programs to combat toxic air are prioritized.

As evidence of the two-week investigation, Prof. Stephen Holgate, an immunopharmacologist and respiratory consultant at the University of Southampton and Southampton General Hospital, said a biological cause of the worsening Ella’s disease during the winter months was seasonal air pollution.

He said it was the cumulative effects of the toxic air Ella inhaled within 30 meters of South Circular Road that caused her most recent acute asthma attack.

The guard

For those unfamiliar with London, UK, South Circular Road is not a main multi-lane road, but rather: “South Circular is 20 miles. Most of the road is single lane, single lane, save for a small stretch of two lane road near the Woolwich Ferry. It is a main road for its entire length. “And” The South Circular has received heavy criticism for congestion and pollution and is one of the least popular roads in the UK. ” [source:  Wiki ]

In this case, we see the sad end of a young girl’s life. A young girl who had suffered from severe asthma for years and was repeatedly hospitalized for asthma attacks and seizures. Somehow, the public health doctors reportedly failed to inform their mother that asthmatics should not live where exacerbating conditions such as high ozone levels, high dust levels, high levels of car and truck fumes on the road exist. Her mother, a school teacher, should have known this, with or without public health authorities to specifically let her know, as all asthma medical websites have this information.

In the end, it appears that a second coroner investigation found that street air pollutants, as is commonly known, can be a trigger for asthma attacks, as is commonly known. The landmark verdict, however, is almost entirely political – what’s shocking is that her family apparently didn’t know the basic facts any parent of an asthma child would know.

As for the cause of death, we see again that it is not always about simple medical facts and that the medical facts can be confused and conflicted with other considerations and popular social movements.

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Author’s comment:

The area I live in, the Central Hudson Valley, New York State, is number 19 on the Allergy Capitals of America list – one of the worst life goals for allergy and asthmatics. Everyone who lives here with pollen allergies knows this and is rudely and painfully reminded twice a year (we are fortunate enough to have two allergy seasons). If a parent of a child with severe allergies tried not to know this simple fact, they would be laughed at out of court.

As for science in the broader sense, the concept of reason is a difficult topic and, in my opinion, is most often misassigned due to vague associations.

As many doctors have pointed out, Covid deaths reported in the media are more correctly characterized as “deaths with Covid” and in many other cases as “deaths with a vague association with Covid”.

Cause of death is simple not easy.

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