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How the Covid-19 Deaths are Counted by the CDC?


Six months into the COVID-19 pandemic, the exact impact of the disease remains a point of debate. According to worldometer, there have been 30 million cases and 1 million deaths worldwide. The USA has been one of the worst affected countries, with over 6.75 million cases and over 200,000 deaths.

The accuracy of these numbers has come into question recently. Some are suggesting inflated numbers. Others believe the death total is higher than reported. Let us help you understand exactly what is going on.

Is Covid-19 being Reported Correctly by the CDC and World Health Organization? Are The Numbers Accurate?

Finding the exact number of cases and deaths is impossible. First is the lack of testing and the nature of the disease. Testing availability has improved recently.

The disease also does not impact all people the same. Some infected people will be asymptomatic and will spread the disease unknowingly.

This lack of clarity has led to accusations that the official records are inaccurate in both directions.

A Colorado Republican has accused the state health department of inflating COVID-19 deaths. In Florida, the department of health has refused to release medical examiner data.

What is often overlooked is how difficult it can be to assign a cause of death. But is any death that is considered “uncertain” a “probable” Covid-19 death?

Cause of Death

Understanding the cause of death assignment process is essential to understanding the reporting on COVID-19 deaths. When a patient dies, either a physician or medical examiner will attribute a cause of death.

Most patients dying of COVID-19 are dying in hospitals, and their physician signs their death certificate. Medical examiners will sign the death certificate if the patient dies outside of a hospital.

In some cities, like Chicago, medical examiners are reviewing each patient who dies in the hospital. This is to ensure that the symptoms and testing show the patient did die of COVID-19.

Medical professionals will list the immediate cause of death, along with the sequence of events that lead to the patient passing. There are also spaces for listing any contributing factors.

In the case of COVID-19, the immediate cause of death might be respiratory distress, with the second line stating “due to COVID-19”. Other comorbidities such as heart, diabetes, or heart diseases are then listed.

This has lead to some people contesting that these contributing factors (heart disease, for example) are what was the real cause of death. But in the case of a respiratory distress fatality, this is not the case. Without COVID-19 being the thing that led to the events that led to death, they wouldn’t have died on that early date.

But, this same process has also led to some cases being misidentified as COVID-19 deaths.

These claims sight anecdotal cases where individuals with COVID-19 have died of other causes but are still coded as a COVID-19 death. Most common are cases where individuals who have COVID-19 have died of heart attacks.

Some medical professionals have come out in support of these claims. Dr. Danile Spitz, A chief medical examiner, explained that “a lot of clinicians are putting that condition [COVID-19] on death certificates when it might not be accurate because they died with coronavirus and not of coronavirus.”

Deaths “Involving” COVID-19 vs Deaths Because of COVID-19

Exactly how we can determine whether COVID-19 was the cause of death depends on the situation. The challenge for medical professionals is to differentiate between those who die with COVID-19 from those who die because of it.

It has been well reported that most COVID-19 deaths are in people who have one or more comorbidities. Most often heart disease, obesity, diabetes, or kidney disease. But, for those who die in a hospital or under medical care, it is usually not difficult to tell what killed them.

Dr. Mary Fowkes explained that most cases are straightforward. The patient’s lungs will be two to three times the weight of healthy lungs. The excess weight being due to fluid and cell detritus from damaged lung tissue.

But in cases where the patient died at home, assigning the cause of death can be more difficult. In these cases, autopsies are the most viable way of determining the cause of death. But even before the pandemic, autopsy rates were low. Many deaths are being inaccurately assigned due to a lack of resources.

A further complication is assigning COVID as the cause of death for younger people who have died of strokes or heart attacks. In these cases, the patients have died of a stroke, and then tested positive for COVID-19 without respiratory symptoms or complications.

Given the novel state of the disease, no-respiratory complications caused by COVID-19 were often not understood nor detected. As we have learned more, we have come to know that COVID-19 can cause blood clots. Studies of brains have shown that in about 30% of cases, tiny blood clots in the brain have caused strokes leading to deaths.

If such deaths are exactly caused by COVID-19 or not is still debatable, but some signs suggest it is.

If CDC is correct than the number of deaths with COVID-19 ONLY as the Cause would equal ***12,526 deaths***

Is the world being scared with over exaggerated numbers???

What Is Happening in Practice?

Given the complex nature of the disease and how and where people are dying, it makes assigning an exact cause of death difficult. In an attempt to bring uniformity and accuracy, The CDC has issued guidelines for how to attribute a death to COVID.

The guidelines urge the use of COVID-19 testing to determine if COVID-19 caused a death. Yet, they also allow for deaths to be listed as “presumed or probable”.

This assessment is based on the symptoms and the clinical judgment of the practitioners. Such guidelines accept the challenging nature of the situation but will lead to inaccuracy.

Inflated or Deflated COVID-19 Reporting?

Reporting on death numbers has always been inconsistent. Now accurate data is more important than before. This data is used to generate an effective public health policy. And to detect strange clusters or identify important risk factors.

Each state has its own rules for reporting and recording COVID-19 deaths. These also differ from national guidelines. These differences make it difficult to get an accurate national picture. States are often reluctant to share their data too. This is because they worry it might be misunderstood, or because they know they have validity issues.

Many have scrutinized Colorado for the discrepancy over people dying with COVID-19 vs COVID-19. Federal guidelines require all deaths with a positive COVID-19 test to be reported to the CDC, even if COVID-19 wasn’t the cause of death. But the state isn’t reporting these cases as COVID deaths.

These inconsistencies lead to speculation about the validity of the numbers. Additionally, the political debate over the response has people questioning if the data is being skewed.

Both overcounts and undercounts are possible, and it is not clear, which is more likely. Or how each impacts the reported numbers. It is not impossible they balance each other out.

Excess Deaths

One of the most relied upon measures to determine the actual impact of the COVID-19 pandemic is excess mortality data. Excess mortality is the number of deaths above what is normally expected or beyond historical comparisons. The CDC data shows a spike of excess mortality for 2020, with tens of thousands of additional deaths.

***important info*** The weekly average of deaths from all causes in the united states is 58,000 per week in 2018 and 2019. That number spiked when covid-19 hit the United States 3/28/2020 until 5/23/20 then when an understanding of the virus occurred, social distancing, herd immunity and medicines improved the weekly average 5/30/2020 until 8/29/2020 is 58,000 a week again.*

Some are arguing that these excess deaths are not entirely attributable to COVID-19. Because people fear catching COVID-19, they are avoiding going to hospitals and doctors for other health needs.

Evidence supports this. The American College of Cardiology found a 38% drop in emergency visits for a specific type of heart attack in March. It is unlikely that the rates of these health incidents are declining. This suggests that some patients requiring medical care are avoiding it, and some would be dying of preventable causes.

Similarly, there is speculation that we may see latency in lockdown related deaths. If cancer patients forego regular screenings and treatments, this could have an impact on death rates nationwide.

Comorbidities, Causes of Confusion.

Claims that the numbers are either inflated or underestimated are citing different sources to support their claims. The primary reason there is so much confusion is that much of the information is being presented without the proper context.

At the end of August, the CDC released a report stating that in 94% of the 180,000 deaths attributed to COVID-19, there were, on average, 2.6 other conditions or causes of death. COVID-19 was the sole cause of only 6% of deaths.

This does not mean they did not die from COVID-19. But that those who have died from the virus had between two and three other diseases that, along with COVID-19, contributed to their death.

The most common comorbidities are other respiratory diseases, diabetes, obesity, circulatory diseases, sepsis, Alzheimer’s disease.

President Donald Trump was amongst many who sighted this report—claiming that the currently reported figures were inflated. These claims sight anecdotal cases where individuals with COVID-19 have died of other causes but are still coded as a COVID-19 death.

Most common are cases where individuals who have COVID-19 have died of heart attacks. Most famously was a Florida man who died in a motorcycle accident, but tested positive for COVID-19 while being treated. His death was coded as a COVID-19 death.

Where Are We Getting Our News?

The Axios-Ipsos coronavirus index poll found a significant divide within the American public. 59% of Republicans and 61% of people who get most of their political news from Fox News believe that the real number of deaths is less than the official report.

61% of Democrats, on the other hand, believed that the real death toll is greater than what is reported. In an election year, it would appear as though COVID is being used for political purposes as much as public health.

This division along political lines is worrying. For something that should be a simple matter of fact to become so contested suggests the public has little faith in the credibility of the nation’s major institutions. Troubling but not surprising as the American public trust in the media has been waning for some time.

The Truth About COVID-19 Death Counts

The reported data is influenced by several factors, varying definitions of COVID-19 deaths, processes for reporting. Lets analyze the wording the CDC and World Health Organization use:

The way the CDC counts the deaths is written on their website under “classification and definition of deaths”

Covid-19 are reported as a cause that CONTRIBUTED to death on the death certificate. These can include laboratory confirmed cases, As well as CAUSES WITHOUT LABORATORY CONFORMATION. If the CERTIFIER “SUSPECTS” Covid-19 or determines it was LIKELY (e.g. the circumstances were compelling within REASONABLE degree of certainty) they can REPORT Covid-19 as “PROBABLE” or “PRESUMED” on the DEATH CERTIFICATE (5,6) Covid-19 is listed as the UNDERLYING CAUSE on the DEATH CERTIFICATE in 94% of the DEATHS

The way the World heath Organization (WHO) counts the deaths is written on their website and it states:

A death due to COVID-19 is defined for surveillance purposes as a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma). There should be no period of complete recovery from COVID-19 between illness and death. A death due to COVID-19 may NOT be attributed to another disease (e.g. cancer) and should be counted “independently of preexisting conditions” that are SUSPECTED of triggering a severe course of COVID-19.

If we expect to know exactly how many people have died of COVID during the pandemic, we will be disappointed. Reporting and data on health and deaths are inaccurate at the best of times, much less so during the pandemic.

We must accept that any reporting is the best estimate. But this estimate needs to be as valid as possible, so health authorities can put in place the best practices and policies to protect the population.

As members of the public, we need to know what we are reading when we are looking at death records. The reported data is influenced by several factors, varying definitions of COVID-19 deaths, processes for reporting.

We also need to be conscious of where we are getting our information. News sources are not entirely independent, especially in an election year. So seeking various reports will give us a better idea of where the truth lies.

No matter which way you look at it, COVID-19 has had a significant impact on national health and our lives.