Oy vey…

I am really getting tired of people taking data out of context and creating fake news from actual news. It’s kind of funny how people who are always shouting that something is “fake news” yet they tend to be the ones who perpetuate it. As many of you know, pictures and various posts calling out provisional death counts cited from the CDC has been circulating the internet. “6%” has been trending on Twitter and other social media sites. What does it mean and why? Of course, our incompetent-in-chief retweeted a post from a suspected QAnon conspirator stating that the CDC covertly sneaked in new data showing that, of the 160,000+ deaths reported up until 8/22/2020, only 6% had actually died from COVID-19. Twitter has since removed his tweet (and many others) by the way of violating its community guidelines about COVID misinformation. The report, found here, says everything but that. Once again, we have lay people playing statistician, scientist, and health expert. As someone who has unfortunately filled out death certificates, let me explain what we try to document on said certificates and then speak to the 6%.

When a patient sadly passes away, a provider has to list conditions the patient had which contributed to the patient’s death to the best of our clinical knowledge. This could be a number of things. Say a patient died from a heart attack but had other conditions. The death certificate requires immediate cause of death and then each condition which led to the previous. So I would put cardiac arrest as the immediate cause of death, then myocardial infarction (heart attack), then coronary artery disease (blockages in the arteries of the heart), then type 2 diabetes, then obesity and hyperlipidemia (high cholesterol). In the instance of COVID-19, a potential cause of death could be listed as follows on a death certificate: cardiac arrest due to myocardial infarction due to ischemic demand secondary to ventricular tachycardia due to sepsis due to secondary bacterial pneumonia due to COVID-19 with related conditions of type 2 diabetes, hyperlipidemia, and obesity. So you see, multiple conditions can exist on a death certificate even though COVID-19 was ultimately the reason for their death.

Now why might the 6% not actually be 6%. This 6% were deaths where COVID was the only listed condition on the death certificate. This could represent healthy patients with no other co-morbidities or simply a poorly detailed death certificate. Some providers are more detailed than others when filling out death certificates and there is not standardized approach.

So let’s say the 6% were those who only had COVID-19 at the time of death. Does that mean the other 94% died from another condition unrelated to COVID-19. Yes and no. Part of the information may indicate that a patient died from another cause and was found to have COVID-19. This can be used to show infection rate and community burden in an uncertain cause of death. However, more often than not, the 94% shows how many people died from COVID-19 prematurely as it related to other associated conditions. For instance, a cancer patient with a good prognosis undergoing treatment who sadly succumbs to the disease would not have “died anyway” as some have stated on social media. Others note that most of the deaths were people of advanced age who were already living past the average life expectancy. So what if your grandmother who is 92, lives alone but independently, is healthy, and has an active social life then contracts COVID-19 and suddenly dies from this. Would she have “died anyway?” Just because some people may not fit into the buckets of what some deem as collateral damage, does not mean their lives are not worth counting. We know that those with obesity, asthma, COPD, diabetes, etc are at a much higher risk of dying from COVID-19. Per the CDC, 40% of Americans, over the age of 20, are obese. It has been learned from multiple studies, including one cited in the Annals of Internal Medicine, that people who are obese can be up to four times more likely to die from COVID-19 than those with a normal body mass index. So before anyone says that lets just run it through our population and obtain herd immunity or that it is only killing old and sick people, you might want to check your own BMI and see if you fit into that dangerous risk group.

If you look at the CDC provisional death report, it shows pneumonia and influenza as other conditions listed on the death certificate. This is often a miscoding issue or those who were reported earlier on in the pandemic when testing was poor and the clinical syndrome was unclear to providers (at least for influenza). Many patients with COVID-19 develop a bacterial pneumonia which develops as a result of damaged or overworked lungs and a preoccupied immune system. This is usually what kills most people who die from COVID-19. Other conditions which some people have may trigger what is called a hypercoagulable state secondary from a pro inflammatory response. In other words, some health conditions which are chronic for some people put them at increased risk of inflammation which is then worsened by COVID-19 when infected. Because of all this inflammation, a person is at an increased risk of developing blood clots in their body. This can lead to a pulmonary embolism in the lungs, a blood clot in the arms or legs, or even strokes. All of which can be fatal if severe enough and not recognized promptly.

So why is such a tweet dangerous? As the ongoing theme has been for most of my blogs…words are dangerous. The hoax rhetoric perpetrated by the president, conspiracy theories overflowing within society, downplaying of the virus’ threat to public health by the federal government, and the sheer denial of medicine and science by the public has led to the continuation of a pandemic which could have been contained months ago. Saying that only 6% of those 160,000+ souls actually died from COVID-19 is an insult to their surviving family and friends. It is an insult to the tens of thousands of true healthcare workers are tirelessly and selflessly caring for sick individuals while risking their own lives. It is an insult to the scientists and researchers who have focused all their attention to this virus and how to better understand it so that we can stop it. This only creates further division in our country because politics and agenda have once again stuck its small, orange fingers in the pot and spoiled the soup. I want everyone to just stop. Stop pouncing on every little post on social media. Stop drinking from the firehose of network media. Stop hanging on every word of each political party. Listen to the scientists and medical/health experts. Objectively listen. Don’t automatically dismiss the facts because it goes against your feelings or beliefs. Try to understand what the facts are actually telling you. Not what someone is telling you.

We are all in this and affected by the pandemic…100%. And whether you choose to believe that or not, it is a statistic no one can refute. So listen to science. Objectively look at the facts.

Be safe, stay well!