Are We Including ‘All Deaths’ of Coronavirus Patients in the Death Toll, Even If They Died of Something Unrelated?

No.

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In a viral tweet Thursday, SpaceX CEO Elon Musk repeated an old claim that everyone with coronavirus who dies is counted as a coronavirus death, even if their death was due to unrelated matters:

The implication is that we are overcounting deaths caused by the virus. The basis for Musk’s claims is a comment made by Dr. Deborah Birx during a coronavirus task force meeting on April 7. “There are other countries that if you had a pre-existing condition and let’s say the virus caused you to go to the ICU and then have a heart or kidney problem — some countries are recording that as a heart issue or a kidney issue and not a COVID-19 death,” said Birx. Misinterpretations like Musk’s caused Birx to clarify what she meant the next day: “So those individuals will have an underlying condition, but that underlying condition did not cause their acute death when it’s related to a COVID infection. In fact, it’s the opposite.” Dr. Anthony Fauci chimed in, calling claims of a padded mortality count “conspiracy stuff.”

The CDC issued guidance for certifying coronavirus deaths in April. The guidance makes it clear that only deaths that were caused by coronavirus can be counted toward the overall mortality rate. Death certificates have two sections for reporting cause of death. The first, Part I, “is for reporting the sequence of conditions that led directly to death,” from the underlying cause of death up until the immediate cause of death. The second section, Part II, is for reporting “Other significant conditions that contributed to the death, but are not a part of the sequence in Part I.”

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  1. Avatar photo
    Zbult

    Alec, all you've done is list the CDC "guidance" on when deaths should be attributed to coronavirus. We know hospitals have a financial incentive to include the virus as a cause (whether immediate or underlying), which they can easily do following the CDC guidance you've described, even if it isn't factually accurate. It might be a conspiracy theory, but citing the CDC guidance doesn't disprove it.

    As for the higher number of deaths "than usual" this could be due to the virus, due to people avoiding normally-recommended medical treatment because of the virus, due to drug/alcohol abuse or suicide, or any number of things - without additional data we don't know. But even if all "additional" deaths are caused by the virus, that doesn't disprove the assertion that hospitals are over-citing the virus as the cause of death.

    Human nature and financial need suggests there's a perverse incentive to over report - I'm skeptical too, but this "fact check" reminds me too much of what we often see from the likes of CNN directed at any conservative they don't prefer.

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    Xsearnold

    I think the jury is out on this. If you look at the CDC's own data you would assume deaths related to COVID-19 are about a tenth of what is being reported by sites such as Johns Hopkins or The COVID-19 Project. Apparently, there is a significant lag in the stats being entered in the CDC site due to the physical review of death certificates coming from states (which will introduce even more lag in the process). To some extent, this is not unusual. The stats counting deaths from influenza ALSO count deaths due to pneumonia under the assumption that these are flu-related, so one could argue that even those stats are overcounted. I believe it is highly probable that, once all the dust settles, the deaths will have been overcounted, although, perhaps, not by a statistically significant margin. I think the large adjustment made by NYC a few weeks ago is indicative of this overcounting. It's understandable that people will err on the side of "caution," i.e., count a death as COVID-related that may not be. Unless we're planning on administering tests to the deceased, I don't see how this can be helped.

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  3. Harvey Cody

    And then there is this: https://www.youtube.com/watch?time_continue=4&v=H5FdnrRR2iY&feature=emb_logo

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  4. Jaybrown

    Lots of numbers flying around, and lots of rather obvious confirmation bias in interpreting them. I guess that's normal, but it is pretty distressing to see the rationalizations of the posters who want to have proof for their belief that deaths are exaggerated because...shutdown bad. "Only pushing the deaths forward a few years, not decades." Indeed. Who could complain about that?

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  5. JakeD

    Sorry, @Dispatch - you picked the wrong hill to plan a flag and fight on. It's impossible to determine whether the death counts are accurate, as someone would literally have to be confident of every test either having been taken, or will be taken. Compound that with plenty of agenda driven sources, and media outlets like Reuters which determines *their own* method of counting, and you have an endless supply of misinformation out there.

    You, Dispatch, have NO way of knowing whether the death count is under or over reported. End of story.

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      Idontdocute

      Thank you

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      1. JakeD

        You're welcome. :)

        Oh, would also like to add from a great article I read today, written by the former chief of neuroradiology at Stanford University Medical Center, here:

        https://thehill.com/opinion/healthcare/494034-the-data-are-in-stop-the-panic-and-end-the-total-isolation

        I'd like to point out for Dispatch readers this point made:

        "Fact 4: People are dying because other medical care is not getting done due to hypothetical projections.

        Critical health care for millions of Americans is being ignored and people are dying to accommodate “potential” COVID-19 patients and for fear of spreading the disease.
        .....

        Treatments, including emergency care, for the most serious illnesses were also missed. Cancer patients deferred chemotherapy. An estimated 80 percent of brain surgery cases were skipped."

        But read the whole thing. It further exemplifies the fact that just trying to say we have way more deaths than we'd normally have, does NOT mean they were COVID deaths. In fact, it's probably more likely that they were deaths caused because people didn't GO TO THE HOSPITALS.

        In many cases, they were downright prevented from going, and in other cases, the fear mongering by the Press and overwrought health professionals and political leaders obviously influenced sick people to avoid going to a hospital where they feared they may pick up the disease.

        But my initial point remains. Unless the Dispatch were actually performing some journalism that actually included leaving the safety of their homes, scouring the country for health records and maybe even visiting some hospitals - they cannot POSSIBLY judge the truth or fiction of reported statistics.

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          Idontdocute

          Well, to be fair, The Dispatch as well as Dr. Atlas' article are both opinion pieces and neither do journalism. I would agree that probably more people have avoided going to the hospital but on one hand a number of people already avoided going to the hospital because of economic reasons or personal objections. I would be wary of just accepting any statistics that just showed the drop in ED visits without considering the usual large number of visits for non emergency chronic conditions that needed a PCP visit or returning to their scheduled dialysis treatments and decided because of risk aversion to return to more appropriate care with their primary support.

          But to the meat of this, considering the strength of transfer within family groups, how would you isolate only the people of advanced age or comorbid conditions because we could already do that in nursing homes and prisons and so far we seem to suck at it?

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          1. Harvey Cody

            People not going to hospitals due to cost does not cover the waterfront. According to the NYTs, if one takes the number of deaths in New York last year and add the number of COVID deaths this year, you come up 4200 unexplained deaths. The article goes on to say, " Although many of the deaths not currently attributed to coronavirus may represent an undercount of the outbreak’s direct toll, the broader effects of the pandemic might have also increased deaths indirectly." "Broader effects" could be entirely the deaths caused by NPI.

            https://www.nytimes.com/interactive/2020/04/27/upshot/coronavirus-deaths-new-york-city.html

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          2. JakeD

            I agree - as I mentioned, my main point remains that w/out a whole lot of accurate data coming in from multiple sources (at the very least) - which the CDC has far more than the Dispatch does - then trying to put out some "We have the Ultimate Truth" article is poor journalism.

            To your other point, we do suck at it, but if we focused our efforts (nationally and more importantly, locally) - we'd likely do a lot better job. But by having ALL of our resources scatter-shotted ALL over the place, we're only making a big ol' mess out of the whole thing.

            If we don't get the American economy back in gear, we face a world-wide depression, given the importance of the American dollar to the rest of the world.

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  6. Mary Stine

    Thousands of humans are dying every day; untold numbers of children will starve in the coming months because of this. We do not have the luxury of arguing about mere numbers..we need to figure out how we can get truly effective accurate testing to happen ASAP. AND we need to get PPE to the frontline workers who are still unprotected. Any ideas??

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  7. Bob

    Part of the problem causing lack of confidence in the data is on 4/14 the counting method was changed, and includes those "probable" deaths where there was no virus test. This wouldn't be so controversial if the two numbers dudnt get jumbled together. They need to be reported separately and when combined, the breakdown needs to be included as a footnote or similar so we all have faith the data set is transparent and the death rate isnt being artificially inflated. Maybe "probable" deaths is 5 % of the total and not important. But maybe it's 50% and highly relevant.

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    1. tla

      I agree. No reason not to be transparent. I hope the scientists studying this have access to the detailed data. I say this as someone who thinks the methodology change was warranted especially given the lack of wide spread testing (especially early on). However, there' no reason to give fuel to conspiracy minded individuals. In general I think we've probably been under-counting as the best measure of the impact COVID-19 is probably the excess death rate, and by that measure we're likely under attributing deaths to COVID-19.

      https://www.nytimes.com/interactive/2020/04/28/us/coronavirus-death-toll-total.html

      That said, I also think without sounding cruel should be measuring the impact in expected life years lost rather than deaths. We're on average shifting deaths forward a few years rather than decades.

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        Idontdocute

        Whatever made you believe we currently have widespread testing after early on, including the testing of the dead. We don't.

        So, in the great American capitalist way, so wherever there is a need, there is a market. We have needed tests for months and I have no reason to believe the government is actively suppressing production, except secondary to regulations. Seriously, why do we not have a surge in availability of tests? They should be at free shipping on Amazon this long into it.

        Is there a thumb on the scale?

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    Brian Andrews

    Who knows what the actual numbers are. I've heard reports of funeral directors in forming families that their love one's death cert lists C19 as cause of death and the family insisting that's not the case.

    Anyway for sure people who otherwise wouldn't, are dying of heart attacks and strokes because they wait to long for fear of going to over crowded hospital full of C19 patients.

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  9. Harvey Cody

    The article is informative, but has some problems and leaves some important things out.

    The biggest problem is that it suggests that Dr. Birx "clarified" her statement of the day before, (which, in substance, said that a death of a person with COVID-19 would be counted as COVID-19 death regardless of the role it played in the death), but she did not address that point at all other than to say, without explanation, she believed the COVID-19 deaths were being undercounted.

    As to the counting to which she referred, was she referring to the counting by CDC, WHO, Johns Hopkins, or some other used by modelers? Even if she was referring to CDC's count, is that the count used by modelers? This is a critical issue omitted from the article.

    The article addressed CDC counting, but Dr. Birx raised a perhaps more important issue concerning the US definition of "COVID-19 Death." She said that the US is defining COVID-19 differently than other countries. Consistency in the data is crucial when countries are compared with each other.

    The article appeared to be engaging in a noble effort to squelch false conspiracy theories. The more important conspiracy theory having to do with Dr. Birx statement is that several groups are trying to make America's response to COVID-19 look bad. Having an exceptionally high death rate would be good evidence for that. Dr. Birx saying that the US counts "deaths with covid" and other countries don't lends credence to the validity of the conspiracy theory. The article not dealing with the bigger of the two issues is a big omission.

    The article quoted from the "Vital Statistics Reporting Guidance" of "April 2020." The article appears to assume that the certifiers of death were operating from that document. When in was it published? The date is important because a lot happened in April, and it was much clearer than the "COVID-19 Alert No. 2" released by the CDC on March 24, 2020. [https://www.cdc.gov/nchs/data/nvss/coronavirus/Alert-2-New-ICD-code-introduced-for-COVID-19-deaths.pdf]

    To rely on something that was not in existence when certifiers started certifying (and, as far as the readers of the article know could have been published yesterday) leaves much reporting to be desired.

    The March "COVID-19 Alert No. 2" says, "If the death certificate reports terms such as “probable COVID-19” or “likely COVID-19,” these terms would be assigned the new ICD code. It Is not likely that NCHS will follow up on these cases." Lot of people who want the number of "COVID-19 Deaths" in the US to be overstated. (This is not to say that epidemiologists and others do not lament every death. This is to say that epidemologist are more interested in working on big deal than a no-big-deals, and others have their own motives for wanting those number overstated.) There is reason to believe the same is true of many death certifiers who have no proof that the death was due to COVID-19. In fact, many of them are likely Democrats who see a political advantage in high death numbers (more blood on Trump's hands can be claimed). Saying "It Is not likely that NCHS will follow up on these [assumed] cases" gave motivated certifiers a green light to overstate, whether that was CDC's intent or not.

    So, COVID-19 deaths do include doubtful deaths. What are the odds 100% of doubtful deaths were COVID-19 deaths?

    The CDC alert also said, "COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death." So, death certificates will have COVID-19 on them if the existence of COVID-19 "contributed."

    What relevance does the language on a death certificate have to the numbers being used in epidemiological data collection or models.

    Without these items having been addressed, I believe the article falls short of the mark.





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    Grandma B

    Every few days I get a FB post from an acquaintance who reposts something from the ‘friend of their cousin who has a neighbor who’s sister is a nurse’ stating that this anonymous nurse has been told to change the cause of death on patients’ death certificate to COVID-19 so the hospital/care center/nursing home (it varies) gets more money from “the government” and that’s why the Coronavirus numbers are a fraud. I point out that I don’t believe that because (1) nurses don’t determine the cause of death and (2) if said anonymous nurse is participating in fraud, that’s a serious crime and there are whistle-blower statutes to prevent that and protect her. Then I get a response along the lines that I’m stupid (actually I used to be a practicing RN) and that I probably believe all the BS “that Democratic plant Fauci” says about something that’s actually less dangerous than the seasonal flu and it’s all a conspiracy to steal the election from President Trump. The bottom line here is that there are subgroups of people who will believe anything as long as it fits into their world view. So, even though I believe your fact check, don’t feel bad if not everyone agrees.

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      Idontdocute

      I am sure that it varies from state to state, but in my state the nurse has nothing to do with the determination of cause of death on notification to the coroner of a death. You are busy enough finding which doctor from which group is going to be listed as the person filling the certificate of death out and be responsible for signing (woe to thee who gets this wrong) the coroner's office phone call list of questions, the required forms related to organ donation evaluation, the meeting the needs of the family, the finding the family member who knows which funeral home to contact for transport and which family member will be available to make arrangements, the phone call list of the funeral home questions and ETA of transport arrival, the gathering of valuables and removal of jewelry for the family, the cleaning of your patient and removal of medical equipment, the forms and questions by the funeral home transport employees including any inventory and full physical inspection for inventory items missed prior transport, and charting of everything above plus notes.

      And now someone thinks there is a conspiracy of impressive proportions to have us find time and accept the risk to file false claims during all of this. wow........

      Might I add a thank you to the Good Lord in heaven for the hospital Chaplins as the gift they are as well as some of the most overlooked frontline heros who take the brunt of so much with so little recognition.

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        cheerio

        I have worked in both oncology and cardiology and seen my share of death. Never have I filled out a death certificate- I would never do that as it is signed by a physician and is an official document. That social media meme is made up to push a narrative.

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      cheerio

      I can relate to your struggle. Sometimes I feel like the country has lost its mind.

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