Conspiracy theories about the Coronavirus epidemic are being
generated faster than people can pull toiler paper off the shelves and that’s
pretty dang fast these days. One claim making the rounds in recent days is that
the CDC is “cooking the books” on COVID-19 by including deaths that were not
caused by the virus. This is a pretty astounding claim, but is it true?
I’ve seen many versions of the claim that the Coronavirus
death count is inflated, but many seem to originate with Fox News’ Brit Hume,
who retweeted a tweet thread that showed that many COVID-19 deaths had
underlying medical conditions. The Twitter user, Adam Townsend, who is a
self-described “investor,” and “extreme salesman” claims in the thread that “NYC
numbers are cooked so that ‘if it died, and it tested positive for COVID-19,
book it.’"
To determine whether Hume and Townsend’s claim is true, I
looked up the CDC guidelines for reporting Coronavirus deaths. The document, “Guidance
for Certifying Deaths Due to Coronavirus Disease 2019 (COVID–19)” from the
National Vital Statistics System is not a secret. It is openly available on the
internet and describes the procedure for classifying pandemic deaths.
Per the guidelines, Coronavirus deaths are subject to a
two-part classification system. Part one of the reporting is where the
“immediate cause of death, which is the disease or condition that directly
preceded death,” is reported. “Other significant conditions that contributed to
the death” are reported in part two.
“If COVID–19 played a role in the death, this condition
should be specified on the death certificate,” the CDC guidelines instruct. “In
many cases, it is likely that it will be the UCOD [underlying cause of death],
as it can lead to various lifethreatening conditions, such as pneumonia and
acute respiratory distress syndrome (ARDS). In these cases, COVID–19 should be
reported on the lowest line used in Part I with the other conditions to which
it gave rise listed on the lines above it.”
The instructions continue, “In some cases, survival from
COVID–19 can be complicated by pre-existing chronic conditions, especially
those that result in diminished lung capacity, such as chronic obstructive
pulmonary disease (COPD) or asthma. These medical conditions do not cause
COVID–19, but can increase the risk of contracting a respiratory infection and
death, so these conditions should be reported in Part II and not in Part I.”
There has been a chronic shortage of testing kits to confirm
Coronavirus infections and the CDC guidelines take this into account as well.
The CDC states that “testing for COVID–19 should be conducted whenever
possible” if Coronavirus is suspected but allows certifiers to “use their best
clinical judgment” if tests are unavailable.
“In cases where a definite diagnosis of COVID–19 cannot be
made, but it is suspected or likely (e.g., the circumstances are compelling
within a reasonable degree of certainty), it is acceptable to report COVID-19
on a death certificate as “probable” or “presumed,” the guidelines note.
In other words, if a Coronavirus infection leads to death,
then “COVID-19” is listed as the primary cause of death. Other ailments are not
ignored, however, as Hume and others allege. Pre-existing conditions are also
listed as contributing factors. Physicians can use their judgment if testing is
not available to confirm Coronavirus but those certifications would be
identified as unconfirmed “probable” cases.
The CDC guidelines are clearly intended to present both
Coronavirus and other secondary causes of death. But what about other
infectious diseases? Are they treated similarly? A 2009 paper in the library of
the National Institutes of Health, “Estimating
Influenza-Associated Deaths in the United States,” sheds some light on that
question.
“For several reasons, the number of influenza-related deaths
cannot be determined solely by reports of influenza-coded deaths,” the authors
say. “First, most adult patients with symptoms consistent with influenza
infection are not tested for influenza. Those who are generally receive rapid
tests of only modest sensitivity. In addition, many influenza-associated deaths
occur one or two weeks after the initial infection (when viral shedding has
ended), either because of secondary bacterial infections or because the
influenza has exacerbated chronic illnesses (e.g., congestive heart failure or
chronic obstructive pulmonary disease). Even when influenza infection is
confirmed by laboratory testing, those results are rarely reported on death
certificates.”
So, flu deaths are much harder to identify than COVID-19
deaths because most patients aren’t tested for the flu and, even when they are,
flu tests are not especially reliable. Further, most flu deaths are due to
secondary causes such as bacterial infections that lead to pneumonia or chronic
illnesses. Identifying flu deaths sounds a lot like identifying COVID-19 deaths
except that there is an added difficulty in that the flu is rarely listed as a
cause of death.
Speaking to Laura Ingraham on Fox
News, Dr. Scott Jensen, a Republican state senator in Minnesota, called the
CDC guidelines “ridiculous” and compared them to flu reporting.
“I’ve never been encouraged to [notate 'influenza'],"
he said. "I would probably write 'respiratory arrest' to be the top line,
and the underlying cause of this disease would be pneumonia... I might well put
emphysema or congestive heart failure, but I would never put influenza down as
the underlying cause of death and yet that’s what we are being asked to do
here."
But, as we have seen, computing influenza deaths requires a
substantial amount of assumptions and statistical modeling. It makes more sense
and is likely more accurate to have doctors at the point of care classify the
death as COVID-19 rather than trying to reverse-engineer the statistics months
or years later.
Jensen also repeats the argument that a person who tests
positive for COVID-19 and dies after a traffic accident could be classified as
a Coronavirus death. However, this is false for anyone following the CDC
guidelines because the virus would not be the “immediate cause of death.” Even
with a positive test, it would be obvious that the virus did not “play a role”
in an auto accident death. Any first-year medical student should be able to
tell the difference between trauma from an auto accident and a respiratory
illness.
Flu death statistics seem much more difficult to calculate
than Coronavirus deaths, yet few people have any problem accepting the CDC data
for flu deaths. The reason is that flu epidemics are not political hot
potatoes. No flu epidemic since the 1918-20 Spanish flu has been serious enough
to warrant shutting down the economy and pandemics don’t usually happen to fall
on election years. Especially considering the president’s
early missteps and the economic upheaval that resulted from the shelter-in-place
orders, the Trump campaign and its surrogates have a vested interest in
minimizing the death toll both to distance the president from as much of the
loss of life as possible as well as to justify reopening businesses as quickly
as possible.
What the Coronavirus “truthers” seem to be pushing for is to
only count COVID-19 victims with no pre-existing conditions, arguing that those
with underlying health problems probably would have died anyway. The truth is
that people with underlying health problems are at higher risk for Coronavirus.
That isn’t a new or unexpected finding. It’s something that has been known
since the beginning (and it also applies to flu patients). Nevertheless, if
someone has a heart problem and is living with it but contracts COVID-19 and
dies a few weeks later, it can be reasonably said that Coronavirus shortened
the person’s life, even if it was not the sole cause of death. If the person
had not contracted Coronavirus, they would still be alive.
Not counting deaths that involved pre-existing conditions
cooks the books in the other direction. If those deaths are excluded, then the
COVID-19 death toll will be artificially low. After all, an underlying health
problem doesn’t mean that the person is going to die within a few months.
People can live for years with heart disease, lung problems, or cancer.
As a Harvard epidemiologist told FactCheck.org,
“There are going to be some people who die of something else, happen to have
COVID and get tested, and get counted as COVID deaths but would die anyway. It
would be wrong to say that number is zero. However, given current testing
shortages and protocols, the number of such cases will be small.”
In fact, the shortage of testing probably means that
COVID-19 deaths are undercounted rather than inflated. Per the Washington
Post, a large number of deaths due to respiratory illnesses in the early
weeks of the pandemic were not counted as Coronavirus deaths because of the
lack of testing. Even now, many people who die at home or in nursing homes are
not being tested or categorized as victims of COVID-19. In some cases, medical
authorities don’t want to waste a test on someone who is already dead. In other
cases, tests can return a false negative.
Drs. Birx and Fauci, who lead the Coronavirus Task Force,
agree that the death toll is not inflated. “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,” Dr. Birx said at a briefing last
week. “In fact, it’s the opposite.”
Dr. Fauci went even further, saying, “You will always have
conspiracy theories when you have a very challenging public health crisis. They
are nothing but distractions. Let somebody write a book about it later on. But
not now.”
It is important to note that even though most of the death
count conspiracy theorists seem to be Trump partisans, President Trump does not
dispute the official record.
“When you say death counts, I think they’re pretty accurate
on the death counts. Somebody dies, I think the states have been pretty
accurate,” Trump said.
As a final proof, it would be too much of a coincidence that
there was such a spontaneous increase in non-Coronavirus deaths that New York
had to reopen a mass burial site to cope with a sudden influx of corpses that
were totally unrelated to the pandemic. The logical answer is that the
increased number of deaths are related to the pandemic.
Despite the claims, there seems to be no evidence that the
government is inflating Coronavirus death statistics. The CDC guidance is very
specific that COVID-19 should be listed only if it is the “immediate cause” of
the death. Even then, guidelines call for contributing causes of death to be
listed as well. If the COVID-19 infection cannot be confirmed with testing, the
death is noted as a “presumed” Coronavirus death. In reality, Coronavirus
deaths are probably undercounted due to lack of testing and the fact that the
large number of deaths is overwhelming medical officials.
We’ll consider this myth busted.
Originally published on The
Resurgent
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