COVID-19 as a cause of death
Sometimes a person’s cause of death is obvious. An accident. Cancer. Heart attack.
But in no small number of cases there are choices to make when a doctor gives an official a cause of death. I’ve seen this many times, even among family and friends. When my mother died at almost 100, there were multiple factors, but perhaps the best choice would have been “old age,” although that did not appear on her death certificate. Another relative, profoundly weakened by cancer that was untreatable at that point, succumbed to pneumonia. I never looked at his death certificate, but it could easily have given either cause or both.
Doctors make these decisions all the time, and the sums of their decisions become the official statistics at the CDC.
For COVID-19, this is how it’s been going so far:
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 [CDC] advises. “In these instances, certifiers should use their best clinical judgment in determining if a COVID–19 infection was likely.”
That clinical judgment, alarmingly, does not require administering a test to confirm the presence of the virus.
“Ideally, testing for COVID–19 should be conducted, but it is acceptable to report COVID–19 on a death certificate without this confirmation if the circumstances are compelling within a reasonable degree of certainty,” the guidelines state.
This is not surprising or unusual – for example, flu deaths are ordinarily based on clinical judgments rather than testing. But it is concerning, because so much is riding on the COVID statistics, reported every day in mounting numbers. In the heat of the moment, treating patients is the primary concern. But record-keeping (both in the US and in countries around the world) needs to be as accurate as possible.
Even if tests were mandatory, however, it still would be difficult in many cases – particularly those involving the elderly and already-infirm – to know whether it was COVID dealing the final blow or something else. Sometimes it’s very clear, for example when a previously hale and hearty person succumbs and the COVID virus has been confirmed by testing. But sometimes it is not clear at all. And it appears that in those cases there is a preference for listing COVID in the absence of knowledge as to whether the person even had the virus.
After all, flu is still going around, and it kills people too. We aren’t ordinarily testing for flu. Are we ascribing some flu deaths to COVID, if the above guidelines are followed? And if so, how many?
Here is a good take from a California doctor on what might cause the deaths and it shows how the timing of treatments makes a big difference. We need all the out of the box thinkers we can find these days.
https://www.foxnews.com/media/california-doctor-develops-process-for-identifying-extreme-covid-19-cases-and-how-to-treat-them
In an ideal world, record-keeping would be as accurate as possible. We do not live on that planet.
I do note the Johns Hopkins daily tally shows only 20,000 as “recovered” in the USA.
Prominent people no longer die of cancer and other fatal illnesses, based on obits. Instead they die of unspecified “complications” of their (inherently fatal, e.g. pancreatic) cancer or whatever. In fact the webmd site headline on McCain reads that he “died of brain cancer” but the text states he died of “brain cancer complications”.
Said complications are merely symptoms and signs of the cause of death, the cancer itself. New language, obscurantist and bizarre. McCain did not die of headaches due to his cancer, did he? No. One does not die of a coma; one dies because of a brain cancer which led to coma.
I expect we will soon read of people dying due to complications from the Wuhan virus.
As I mentioned in another thread a couple days ago my dad had a cancerous brain tumor and eventually got pneumonia and died of that but his cause of death was listed as lung cancer which the doctor freely admitted they had no proof of but the type of brain tumor he had usually comes from lung cancer so they assumed it was there and since he had been a smoker they’d listed lung cancer.
Like so much of the key information around this virus the numbers and facts are so incomplete and easily manipulated it just makes it more alarming that they are used to make such massive decisions.
I’ve been seeing more about expat’s topic. Some doctor said that the problem that older people have with the virus is that their immune system gets more sensitive or more powerful (one or both?) with age. Then with COVID-19 they develop a cytokine storm or CRS, cytokine release syndrome, and the inflammation from that kills them.
Cicero:
I’ve already seen that “complications” designation in connection with COVID, and wondered about it.
Hospitals are going broke.
No elective procedures.
Not Covid? Stay away!
But there’s money to be had budgeted to Covid.
So tag that toe “Covid.”
I’ve seen reports that the feds will cover covid expenses not covered by insurance. There’s a reason, especially to facilities which have run themselves ragged and perhaps even lost staff to the disease, to choose “covid” instead of pneumonia (which might justifiable), or instead of something further from the truth.
In my travels I have come across one place where a digging implement is usually referred to as a spade and there appears to be a top-down campaign to fight the tendency toward obscurantism in word and deed; this even happens in most government pronouncements. This place is Singapore.
It may be that Western Liberalism taken (more correctly Universalism) taken in the large simply cannot handle the truth and is in fact antithetical to it.
A benign one party state dictatorship founded by one of the most intelligent (I didn’t say Minnesota Nice) politicians ever to live *must* keep its eye on the ball of verbal truthiness given forces of internal Entropy and the vehement hatred of our Best of the West.
Back to the topic.
I guess doctors tend to write most proximate cause of death on the Death Certificate in order to avoid legal complications. It’s kind of stupid in the case of someone who dies in a hospital and proximate cause of death is ‘Heart Failure’ when really you had a GBM IV and eventually lost swallow reflex and died when you dehydrated beyond some point and your circulating blood volume/viscosity became an issue. It sounds silly.
But then in another part of the hospital, a rogue nurse is offing his/her patients as the opportunity presents itself. Or maybe not a total psychopath; perhaps she only does it when she’s on the rag. Or maybe only occasionally if doesn’t like some patient’s manner. These things happen. If I were a doctor, I’d be very keen to always write down proximate cause of death because in the back of my mind there’s always the Coroner (or jurisdictional equivalent) looking over my shoulder.
We live in a fallen effed up world. All our statistics are like this. Fortunately there are techniques to tease truth out of data sets… but like anything involving the truth in the real world, it’s more a case of sidling up to it than bravely striding towards it. And by fits and bounds with reverses. Always the reverses.
All we can do right now is look at gross death counts and visual cues like large numbers of people dying at home or outside hospitals. If see *those* as we did in leaked Wuhan videos then can believe our lying eyes.
Neo, according to a couple articles I read today the numbers in NY are actually being under reported for people who die in their home. They are not counting the deaths as attributed to COVID-19 unless they can verify and confirm the cause. The number of deaths is so high in NYC that they are not verifying as much now.
As of Monday afternoon, 2,738 New York City residents have died from ‘confirmed’ cases of COVID-19, according to the city Department of Health. That’s an average of 245 a day since the previous Monday.
But another 200 city residents are now dying at home each day, compared to 20 to 25 such deaths before the pandemic, said Aja Worthy-Davis, a spokeswoman for the medical examiner’s office. And an untold number of them are unconfirmed.
The FDNY says it responded to 2,192 cases of deaths at home between March 20th and April 5th, or about 130 a day, an almost 400 percent increase from the same time period last year.
That number has been steadily increasing since March 30th, with 241 New Yorkers dying at home Sunday — more than the number of confirmed COVID-19 deaths that occurred citywide that day. On Monday night, the city reported 266 new deaths, suggesting the possibility of a 40% undercount of coronavirus-related deaths.
https://gothamist.com/news/surge-number-new-yorkers-dying-home-officials-suspect-undercount-covid-19-related-deaths
The “If the rest of the country winds up like New York” tracker for April 7, 2020, stands at a bit over 93 thousand dead nationwide.
Mike
Once again, cognitive dissonance is ruling the game.
https://theconservativetreehouse.com/2020/04/07/white-house-coronavirus-task-force-briefing-500pm-et-livestream-11/comment-page-4/#comment-8043580
(quoting from a Tweet)
And yet I’ve been reading stories about people who present the symptoms, but can’t get authorized to have a test so they can get treatment.
Crazy is not even close.
Overcounts may be balanced by undercounts in NYC.
Gives an informative look at the abnormal number of 911 calls and cardiac arrests.
https://gothamist.com/news/surge-number-new-yorkers-dying-home-officials-suspect-undercount-covid-19-related-deaths
Without in any way intending disrespect to the sadly departed and their families:
The coding of any death with COVID as death by COVID lends itself to somewhat irreverent memes.
https://pbs.twimg.com/media/EVCo-RPX0AUVTg4?format=jpg&name=900×900
Mike:
Keep that hobby horse rocking. Hoping for the worst outcome? Inconceivable, I know.
A reminder from Steven Hayward.
https://www.powerlineblog.com/archives/2020/04/experts-pseudo-experts-and-other-progressive-conceits.php
Montage and AesopFan:
First of all, I don’t think much of the Gothamist, a site with which I was previously unfamiliar until reading this article and the comments therein.
But aside from that, I would add that apparently that report about deaths at home is based on this data. When I look at it, I see a few things right off the bat. The first is that those deaths at home are for both heart attacks and respiratory problems, but I don’t see any attempt to differentiate. So one thought that occurs to me is similar to this:
What this means is that deaths that would otherwise be recorded as occurring in the hospital are now recorded as having occurred at home. However, obviously it’s not all due to that, because there are also a lot more calls for EMTs than during the same period last year. But that could be (at least in part, or maybe mostly) because people who would otherwise go into the ER themselves because of their symptoms (for example, of heart attack), are avoiding going into the hospital at all, and are dying of heart disease at home. People are afraid to go the ER for fear of getting COVID.
What’s more, there’s also this:
In other words, even if a person dies at home, if that person has had a positive COVID test, then that death is added to the COVID statistics. That information comes from a politician, not a health professional, so it’s hard to know what it’s based on.
The article closes with this:
That was written today. Why no comment?
It’s hard to follow the evidence if they — delete it because it was wrong.
https://www.thegatewaypundit.com/2020/04/huge-covid-tracking-website-deletes-information-hospitalizations-icu-patients-tgp-reports-numbers-fall-bogus-model-predictions/
The embedded Tweets, which I can’t copy and thoroughly detest, cite the problem of getting counts of different things from the states (some current hospitalizations, and some cumulative), which they were conflating on their charts.
Neo – thanks for the response.
The Gothamist post on home deaths (which I picked up from another site) didn’t seem rabid and the commenters were both left and right winged.
Also (I went over and took another look), these two posts seem like normal (that is, unbiased) reportage, with bipartisan commentary (so they aren’t censoring one side).
https://gothamist.com/news/rent-crisis-looming-state-lawmakers-want-pause-evictions-through-december
https://gothamist.com/news/city-transparency-coronavirus-demographic-data
When dealing with actual facts and figures, Gothamist seems to do okay, unlike the ideological hit piece on Samaritan’s Purse.
(A sample of 4 is not statistically significant!)
It’s pretty clear the writers & editors have certain triggers that bring out the bias.
But —
“Forget it, Jake, it’s Gotham town.”
The progressive liberals have figured out a way to stop the pandemic.
https://libertyunyielding.com/2020/04/07/cartoon-of-the-day-cornaviruscure/
This isn’t really a thread just about New York, but I don’t know how to put all of this together in my head.
April 4
https://legalinsurrection.com/2020/04/ny-gov-andrew-cuomo-orders-national-guard-to-seize-ventilators-from-upstate-hospitals/
April 6
https://www.breitbart.com/politics/2020/04/06/andrew-cuomo-we-dont-need-any-additional-ventilators-right-now/
April 7 (but it happened earlier, back when NY declined to buy ventilators)
https://www.breitbart.com/health/2020/04/07/report-new-york-city-auctioned-off-ventilator-stockpile/
Amidst the legitimate concerns, cautious skepticism, and outright carping about the (as it seems now) overly ominous projections of the models, we* need to be sure that we don’t miss the essential point:
We were all terribly afraid that those models were right, did everything we could to make their projections wrong, and apparently (hopefully) succeeded.
Whether the models were faulty to begin with or not, there is a singularly important bottom line:
We don’t want those “excess” hospital beds to be filled.
Unused medical capacity is not some kind of “wasted effort” — if nothing else, we had a shake-down drill for some future pandemic when the projections won’t be wrong.
We learned a lot of important lessons, which I won’t attempt to detail at 3 am my time, but foremost among them may be this one:
In this era, the single greatest sources of danger to the health and safety of the public, world-wide, are the governmental agencies tasked specifically with protecting health and safety, and their political overlords bear a large share of the responsibility for that deficiency, beginning with the venal, malicious, and criminally negligent Chinese Communist Party, but definitely not stopping there.
In particular:
Anyone continuing to argue for socialism in America, complete or partial, is spitting in the wind.
*”we” refers to the normal, mostly sane, populace, and not to TWANLOC, to use a phrase that has become increasingly, and obviously, applicable to a really frightening portion of Americans.
If you aren’t inclined to look it up –
Those Who Are No Longer Our Countrymen
Proverb:
https://www.urbandictionary.com/define.php?term=spit%20in%20the%20wind
A futile act is “spitting in the wind.” So is a selfless but unheeding act that “boomerangs” or has dire consequences the doer hadn’t contemplated, an act that “did more harm than good.”
Or the short version:
Avoid socialism like the plague.
Again, our prolific hostess leaves me many choices to post my update, so here it is on this thread which seems most relevant.
Active cases still fit with the sigmoid function. An uptick yesterday in the new cases adjusted the sigmoid fit upward with the start of the flattening now out to Saturday/Sunday. I know it seems like I’m moving goalposts, but as we get closer to the curve bending, small changes in new cases affect the fit more than in the exponential region. I can predict the number of active cases when the curve really bends to be around 475,000. Serious cases has been linear for 3 days running, which if it continues, should also start to show up in the death rate.
I would suggest for everyone to check Willis’ data on death rates for countries and states everyday. He does a good job so I don’t think I need to reproduce what he does. I’ll stay with active/serious case fitting.
https://wattsupwiththat.com/daily-coronavirus-covid-19-data-graph-page/
The ‘watt’s up with that’ blog leads to major spam and potential computer virus links. Be wary of the link… I tried to go there twice. Then tried via Google to find the blog. Nope. My computer does not like it.
Montage:
Use Brave browser and you will avoid the spam and other malware that got on to the “watt’s up with that” blog.
I had the spam and such using Google Chrome browser yesterday but none with Brave and of course I use a separate antivirus and malware application.
Never had a problem at all with WUWT. I use Firefox with Norton. Google being Google it’s well known they have a vendetta against “deniers”, soo…………….
om – can outside hackers drop malware onto a blog? How does that work?
I visited WUWT on Chrome regularly, until I switched to Brave & duck-duck-go for my New Year’s Resolution, and never had any problems then.
(Just went over to look at the site and Brave blocked 11 cross-site trackers immediately.)
“I use a separate antivirus and malware application” – which ones?
BTW, if you haven’t read through Willis’s note at the beginning of the post, scroll down and get a look at the phone-booth style sample collection cubicles in South Korea.
Brilliant.
Me quoting me above: “In this era, the single greatest sources of danger to the health and safety of the public, world-wide, are the governmental agencies tasked specifically with protecting health and safety, and their political overlords bear a large share of the responsibility for that deficiency, beginning with the venal, malicious, and criminally negligent Chinese Communist Party, but definitely not stopping there.”
..and adding some chastisement of the intertwined media.
https://wattsupwiththat.com/2020/04/07/coronavirus-blowback-trump-to-withhold-funds-from-the-china-centric-un-who/
https://wattsupwiththat.com/2020/04/02/senior-who-advisor-urges-a-climate-action-response-to-covid-19/
https://wattsupwiththat.com/2020/04/07/journalists-strategising-how-to-insert-climate-action-into-coronavirus-rescue-packages/
AesopFan:
I don’t know the ins and outs of spammers and worse critters of the Interwebs but others here may be able to answer your query.
I’ve been using eset NOD32 for years but don’t know if other apps are better.
I agree with your assessment that Willis made. Our (Feds and most Governors) one size approach fits one case, every other case suffers. Just as every place in the US can’t be NYC. 🙂
There is a piece from a Jacksonville FL TV station wailing about CV…
https://www.news4jax.com/news/florida/2020/04/08/florida-coronavirus-cases-near-15500-as-deaths-top-300/
Headline:
Florida coronavirus cases near 15,700 as deaths top 300
Ohhhhhh, NOOOOOes!?!?!?
*sigh*
Let’s put this in context… AGAIN.
THE FLU, from Oct 1 through March 28 (180 days) killed from 24000 to 63000 people in this nation.
Florida, with a population of 21.3 million out of 330 million is about 6.4% of the US population (note, there is another factor, age, which may be relevant, but that, if anything, skews florida’s expected results UP, making the below calculations conservative)
So…
(24000*0.065)/180 = 8.7 people PER DAY in FL
(63000*0.065)/180 = 22.75 people PER DAY in FL
So, not sure when you want to consider the “start” of this — seems to me that it began about 6 weeks ago, but let’s go with 4 weeks — a month. Call it 30 days.
In 30 days, THE **FLU** — your everyday, garden-variety FLU — killed 260 to 682 Floridians.
I ASSERT:
THIS IS A BAD FLU.
THAT’s ALL IT IS.
https://web.archive.org/web/20200408090650/https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm