Internet COVID-19 stories I have checked, part 2

By Simon Wheaton-Smith

Stories go around the internet which are expanded and repeated. These stories usually have the seeds of truth. I am neither a doctor nor lawyer, and I can be wrong about my take on such stories, but here is my personal analysis of one of them.

The quote I received was "The CDC website disclosed the shockingly small number of people who died from only the Wuhan coronavirus, with no other cause of death mentioned. Hold on to your hat because here it is: out of the 161,392 deaths in the CDC data, just 6%, about 9,700 deaths, were attributed to the coronavirus alone. According to the CDC, the other 94 percent had an average of 2.6 additional conditions or causes of deaths, such as heart disease, diabetes, and sepsis."

I found the 6% number on the CDC web site under a sub heading Comorbidities.

A long term friend of mine, Dr Pugh MD who specialized in tropical diseases, agreed with the quote "This does not mean that someone who has hypertension or diabetes who died of COVID didn't die of COVID-19. They did"

If that all works for you, then read no more. Otherwise I shall dig deeper.

The death certificate Part 1 allows 4 entries, the first is the cause, the next three are "due to or as a consequence of". The CDC statement simply says about 6% listed COVID-19 as the only entry in the death certificate in Part 1. So the other 94% referred to COVID-19 as a cause of death and had additional factors. That means COVID-19 was the ultimate cause of death but that other things were going on.

A question to ask might be "is there any incentive for a doctor to place COVID-19 on the death certificate when they did not believe COVID-19 was the real cause?" The internet story does not even suggest doctors can't fill in death certificates properly, nor does it suggest doctors benefit in any way from saying COVID was the ultimate cause when it wasn't.

At this point I had serious doubts about the meaning of the internet story, but I did accept the 6% figure. I continued on, if one assumes death certification errors were mistakes and not intentional then how many errors were made?

Tracking deaths seems to use a couple of methods, and those methods do not always exactly agree. It appears some deaths recorded as COVID-19 may be questionable; the worst example I found was an over reporting of 9% in one state, however, more common was about a 0.5% error. Some states used the two common methods and then resolved those differing numbers. Even if one assumed that every state in the union had a 9% reporting error, then with 184,083 CDC reported deaths (as of 9/2/20), it would still leave a final count of 167,515 deaths and that is still a very large number. It suggests the internet data, while correct, may have been misinterpreted.

Next I looked at the CDC guidance on death certificates, as well as the international standards which the CDC follows. One concern I had was clarified by "It is important to write the cause of death (e.g. chronic obstructive pulmonary disease) rather than the mechanism of death (e.g. respiratory failure). That explained why Part 1 of the death certificate said what it did and it was more helpful in tracking why deaths were occurring.

I suggest other ailments that developed after infection, would clearly not invalidate a death due to COVID-19.

But wait, there's more. What if the patient had pre-existing conditions? Part 2 of the death certificate may include those as "other significant conditions contributing to death but not resulting in the underlying causes given in Part 1". Part 2 simply means contributing to but not resulting in the Part 1 causes. Do we trust doctors to get this one right? If not, change your doctor.

As an aside, there are other ways of analyzing overall death counts, one such is "excess deaths" which is defined as "the difference between the observed numbers of deaths in specific time periods and expected numbers of deaths in the same time periods. …. Weekly counts of deaths are compared with historical trends to determine whether the number of deaths is significantly higher than expected." Using the CDC excess death dashboard to show all deaths, actual and excess, it shows that in the entire country just for the one week ending April 4, 2020, there were over 15,000 excess deaths. This more academic method again would not easily support a claim of only 9,700 deaths total due to COVID-19 for the entire pandemic; even though it is a more abstract approach and not COVID-19 specific

Conclusion: This internet story quotes the CDC correctly, however it needs a closer look at how death causes are indicated, collateral medical issues, how pre existing factor do or do not come into play, and finally a big picture view of excess deaths. CDC guidance says simply that if COVID-19 is the cause, say so. Doctors are trusted persons, they have no incentive to state COVID-19 when it is not. I find the internet story to be true as to the 6% data, but that the interpretation of the internet story is questionable.

My opinions are personal, and I can be wrong; what is important is that we question what we read or hear, and then and only then coalesce our thoughts before passing them on to others.

My references below are a mix of government sources (some trust them, some do not) as well as news outlets (some trust them, some do not). Many other sources exist.

Reference:

https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm (has the 6% figure)

https://www.cdc.gov/nchs/data/dvs/blue_form.pdf

https://www.cdc.gov/nchs/data/misc/hb_cod.pdf

https://crvsgateway.info/The-International-Form-of-Medical-Certificate-of-Cause-of-Death~356

https://www.mypcnow.org/fast-fact/completing-a-death-certificate/

https://www.who.int/classifications/icd/Guidelines_Cause_of_Death_COVID-19.pdf?ua=1

https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf

https://covidtracking.com/blog/confirmed-and-probable-covid-19-deaths-counted-two-ways

https://www.cdc.gov/nchs/covid19/coding-and-reporting.htm

https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm#dashboard