Inquest - Coronavirus

Inquests following Death by Coronavirus Covid-19

(updated 04 May 2020)

Not every death will result in an inquest taking place but some deaths, which arise out of contracting Coronavirus Covid-19 will justify a coroner calling for an inquest to take place.

An inquest into any death is an enquiry into the circumstances surrounding the death; it is not a forum for pointing the finger of blame although the conclusion (once called the verdict) may lead to allegations of responsibility. Although family members have a right to be heard, in person, at an inquest, the process may be daunting and therefore specialist advice can greatly assist, to identify the issues to be addressed and the questions to be asked of those who are able to give evidence of the circumstances of an individual’s death.

When will an inquest take place?

 An inquest will be held by a coroner where there is:-

·         a violent or unnatural death;

·         where the cause of death is unknown; or

·         the deceased died in custody or otherwise in state detention.


Will there be an inquest into every death by Coronavirus Covid-19?


Broadly, coroners conduct inquests into a death when that death has been from an unnatural or violent cause, where the cause of death is unknown or where the deceased has died in police custody.

A death is typically considered to be unnatural if it has not resulted entirely from a naturally occurring disease process running it is natural course, where nothing else is implicated.

Although every case is different, Covid-19, as a cause of death (or contributing cause) is not a reason on its own to refer a death to a coroner, for an inquest to take place. If the medical cause of death is Covid 19 and there is no reason to suspect that any culpable human failure contributed to the death, there will usually be no requirement for an inquest. Therefore, there will often be no reason for deaths caused by Coronavirus Covid-19 to be referred to a coroner.

Covid-19 is a naturally occurring disease and therefore is capable of being a natural cause of death. However, there may be additional factors surrounding the death which means a report should still be made to a coroner. Consequently, where someone was diagnosed with Covid-19 and dies, but the cause of death is unclear, those circumstances may lead to an inquest taking place. A number of inquests opened where the deceased had tested positive for coronavirus.

If the coroner decides to open an investigation, they may need to decide whether any failures of precautions in a particular workplace caused the deceased to contract coronavirus. Also, if there were reason to suspect that some failure of clinical care of the person in their final illness contributed to death, it may be necessary to have an inquest.

A significant area of concern during the coronavirus has been the lack of PPE. If the coroner considers that a proper investigation into the death requires evidence or material be obtained in relation to matters of policy and resourcing, such as providing PPE for doctors and nurses, the coroner may suspend investigation until it becomes clear how such enquiries can best be pursued.

However, the Chief Coroner has said that an inquest is not the right forum for addressing concerns about high level government or public policy.

The Labour party has responded, warning that this advice from the Chief Coroner could limit the scope of investigations into the consequences of PPE shortages.

Our view is that for justice to be done there needs to be a full and proper enquiry into the circumstances of each and every death caused by the coronavirus where the possible lack of PPE has played a role in the health workers death. Only by an inquest and understanding of all the key factors, will we do justice to the families and ensure that in future situations adequate PPE will be available substantially in advance of any such crisis

Will there be a post-mortem following a Coronavirus death?

 A post-mortem will be carried out in advance of the inquest. Clearly, the issue of PPE (personal protective equipment) is important at any time, but more so during the lockdown. Public Health England state that guidance issued by the NHS for treating Covid-19 patients should be applied when in the proximity to or when handling a body. This does not directly affect family members, but those who are handling the body and carrying out the post-mortem.

Will inquests proceed during the lockdown?

 The requirement by the government that people should stay at home during the lockdown except in limited circumstances, means that there is an impact on all inquests.

Guidance from the Chief Coroner states that no physical hearings should take place unless it is urgent and essential business. Furthermore, hearings, with physical attendance by people, should only proceed if it is safe for those involved to do so. A particular concern is to ensure social distancing in court and in the court building.

All hearings that can take place remotely (using technology) should do so. Although the courts have been using technology for some while, is not always reliable although just as in other work places, the court system is learning fast, to enable judicial business to proceed as efficiently as possible.

Will the Coronavirus inquest hearing being in public?

The general rule is that inquest hearings should take place in public but that will prove difficult during the pandemic. During the lockdown hearings taking place in public may mean they take place where only a member of the immediate family is present and with a representative of the press also in attendance.

In ordinary circumstances there would be no limit on the number of family members present but restrictions have to be put in place for the safety of those who are attending the inquest hearing.

Will social distancing apply at the inquest hearings?

Yes. Social distancing must be in place at all times and all places within a court building, when physical hearings take place.

I am waiting for an inquest hearing. Will this be delayed?

It is likely to be delayed because of the difficulty in having all the interested persons available to attend the inquest hearing. It is inevitable that there will be adjournments and that an adjournment will cause the number of cases to be heard over the next 12 months to increase. This is likely to cause further distress to grieving families, looking for answers and the full facts as to what factors played a part in their loved one’s death.

Have any Inquests concerning Coronavirus taken place?

Very few inquests involving coronavirus have taken place so far and the expectation is that they will not normally be necessary following the issue of guidance from the chief coroner for England and Wales. However, there have been significant findings following the hearing of two inquests that have resulted in the coroner issuing “a prevention of future deaths” report.

The two cases involved elderly men, one who contracted coronavirus in his care home and the second as a hospital patient. Concerns raised by the coroner in the care home case included how the virus had entered the care home, infection prevention measures, policies concerning the wearing of protective personal equipment by staff and a shortage of ambulance staff to convey patients to hospital. The inquest into the death in hospital raised concerns over the management of patients in hospital with the indication in this case being that the patient, who was being treated for a fracture, was placed in a bay where the previous patient had tested positive for coronavirus.   

The coroner’s reports have been sent to relevant bodies including NHS England, Public Health England and the Care Quality Commission, and they are required to respond officially to the coroner.

 Where can I get more information on Coroners Inquests?

 We have a wealth of experience and information online to assist. If you would like further advice, do not hesitate to contact us.

What should I do if I need Coronavirus Covid -19 inquest advice?

 If a relative has died having tested positive for coronavirus it does not necessarily follow that there will be an inquest. Each death will be considered individually. However, where a coroner considers an inquest should be held, do not hesitate to seek legal advice. We can give preliminary advice, gather information, documents and evidence in advance of the inquest and provide representation for you, the family, at that inquiry.

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