94% 6% What did the CDC Say?
It’s been a few days since the CDC released data saying 94% of Covid-19 deaths had underlying medical conditions in addition to positive Covid-19 diagnosis. But I still see this misinformation being spread around — so I’d like to address this today.
The way this has been interpreted is that the CDC “quietly updated” its COVID-19 data “to admit that only 6% of all the Covid-19 deaths recorded actually died from Covid-19”. This is blatantly UNTRUE.
What was this CDC report? It was essentially a table where they broke down all the deaths due to Covid-19 to assess the types of health conditions and contributing causes mentioned in conjunction with Covid-19 on death certificates. These included things such as pneumonia, respiratory failure, cardiac arrest, sepsis etc.
Before we go any further, let’s talk about what goes into a death certificate. Death certificates have several lines on the report that must be filled out (see picture below). These involve multiple diseases or conditions that either lead or contribute to death. Importantly, remember that things such as respiratory failure and cardiac arrest are not CAUSES of death but MODES of death. For any death, there are usually several causes listed and modes listed. It is very rare to only have a single cause of death, typically this means that the death certificate may not have been filled correctly. Many thanks to my friend, Merry, who has an extensive background in mortuary schooling who explained this to me.
So what does that mean for Covid-19? Dr. Spencer Pruitt, an ICU physician, explains it nicely in his post. He says, as an example, if a patient with Covid-19 comes into the ICU. Middle aged, high blood pressure that is well-controlled on medication, previous smoker. He gets pneumonia due to Covid-19. This caused ARDS and subsequently resulted in him being on a ventilator. Unfortunately, the central line to help get medications into the patient results in a blood infection — sepsis, that then results in his death. Would the patient have had sepsis if he didn’t have Covid-19? The answer to that is no. So, what goes onto the death certificate? Sepsis? ARDS? Pneumonia? Hypertension? Smoking? Or all of the above? As Dr. Pruitt says, he followed the rules and put: Proximal: Sepsis. Secondary: ARDS, Pneumonia, COVID-19.
On the CDC table, this patient would have been in the 94% that had conditions that contributed to his death.
But would he have died if he didn’t have Covid-19? We know that chronic medical conditions can increase your risk of mortality (death) from Covid-19. However, it is important to note that most of these chronic conditions, when well-managed/controlled, likely would not have resulted in death this year if not for Covid-19. We have seen a significant increase in ‘excess mortality’ in the months from February to August, 2020 when comparing to previous years. This helps explain that even accounting for deaths due to underlying conditions, the number of those that died this year has been well above what we would see in typical years. Dear Pandemic has a wonderful post explaining this in detail. This is also why measuring excess mortality gives a clearer picture of the pandemic’s true burden.
Importantly, this misrepresentation of the CDC table is not only incorrect, but very ableist. Nearly 1 out of 2 adults in the United States has hypertension (108 million). Are we saying that anyone with co-morbidities is expendable and deserves to die an untimely death?
Bottomline: The CDC is not over-counting deaths due to Covid-19. These deaths would most likely not have occurred if not due to Covid-19. Importantly, those with pre-existing medical conditions — a huge percentage of our population — deserve respect and are not expendable.