Sunday, April 12, 2020

Is The CDC Really Inflating Coronavirus Death Statistics?

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, “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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