www.ramsdale.org/death1980.htm
Random 80s death certificate that came up online, you can see the three contributing causes to the death in a list format. If the death happens in hospital the hospital will supply you with paperwork to take to the registrar. If the death happens outside of hospital a visiting doctor does the paperwork that you take to the registry office. In some circumstances the death has to be referred to a coroner for post mortem (and sometimes an inquest will follow - the only time I have done jury service has been at coroner’s court):
secure.manchester.gov.uk/info/626/coroners/5532/when_death_occurs/2
Sometimes the reasons for death can seem quite surprising and I believe you can query them?
When my mum died (in hospital, 15 years ago) her death (IIRC) was recorded as multi organ failure due to septic shock, caused by a perforated bowel.
That seemed weird because her bowel perforated because she’d just had her first chemo for a relapse of ovarian cancer, but as her ovaries were long gone, her ovarian cancer cells had attached to her bowel. The chemo killed the cells, damaging her bowel in the process.
If she hadn’t had chemo on the Thursday, she wouldn’t have died on the Sunday. If she hadn’t had ovarian cancer, she wouldn’t have needed the chemo, yet neither of these factors were entered into the statistical record for cause of death. Back then, ovarian cancer only had a 20% survival rate at 5 years post diagnosis, according to all the relevant cancer charities, but in the years since I’ve often wondered how accurate any of those statistics can really be, considering what I know about my mum?
(Ovarian Cancer was in the ‘other conditions’ box but who knows how these things are recorded and selected when statistics are compiled?)
Deaths in connection to AIDS have always reported as ‘AIDS related illness’ and I believe that’s a similar phenomenon to what we are seeing now - most AIDS patients will actually have died of something else, but if they didn’t have AIDS, the something else might not/probably wouldn’t have killed them.
According to this, currently globally, the leading cause of death in those living with HIV or AIDS is Tuberculosis:
www.avert.org/global-hiv-and-aids-statistics
I can’t find a quick and easy link of U.K. HIV/AIDS related deaths (thankfully it’s now a small data set) but a quick flick through a couple of studies suggests that cancer and hepatitis are probably the leading causes of death in this patient population.
TL:DR The way cause of death is decided is actually quite complicated and varied and that’s always been true, rather than being CV19 thing.
IMO it’s right that multiple causes are recorded, but it’s still surprising as to which 2 or 3 contributors a doctor will decide to record.
Here are the .GOV guidance notes for docs on recording cause of death (relevant screen shot attached): assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877302/guidance-for-doctors-completing-medical-certificates-of-cause-of-death-covid-19.pdf