Cause of Death

Weekly Excess Deaths, as tabulated by the CDC. Not the late spike from COVID-19.

This seems to be OT’s week for thought experiments, so let’s do another one.

Let’s pretend that you can’t walk without the assistance of a cane. I, being a jerk, come up and give you a shove. It’s a shove that might tumble a person who walked unassisted. But with your impairment, you easily tumble to the ground. Then when you yell at me, I say, “Hey, it wasn’t my fault. It was the cane’s fault!”

That would obviously be insane, right? That would be the mark of a sociopath. And yet this would be similar to the chain of logic that has led the Q hive, multiple celebrities and even the president to claim that 94% of COVID deaths are not really from COVID.

This weekend, a tweet went viral claiming the CDC had “quietly” updated it’s data to show that only 6% of the COVID-19 deaths are actually from COVID-19. The other deaths attributed to COVID-19 are listed as having come from things like heart attack, pneumonia or kidney failure. The claim that the CDC had “admitted” that COVID-19 deaths were vastly exaggerated was then amplified by Gateway Pundit (aka, “The Dumbest Man on the Internet”¹, lit up COVID denialist Twitter and was even RT’d by the President himself². But is this true? Of the nearly 180,000 deaths attributed to COVID-19, are only 9,000 from the virus? Did most people actually die with the virus rather than of the virus?

No.

First of all, the CDC did not quietly anything. They have been publishing this data for months. Someone ignorant of how data works suddenly noticed it and drew the wrong conclusion.

Second, what the CDC lists is not what people are claiming it is. “Cause of death”, as listed on a death certificate or medical record is … complicated. I’ll let Orac, in a holy-cow-you-should-really-read-the-whole-thing post explain:

To understand how the CDC table was tabulated, let’s elaborate on the Tweet above. You have to understand that it was compiled from standardized death certificates. It’s been a long time since I’ve had to fill out a death certificate—thankfully!—but I still remember how they work. On the death certificate form, there is a space for the immediate cause of death and then several lines for underlying causes. In brief, death certificates are filled out by the medical certifier (who can be the physician who had treated the patient before death), who provides his best medical opinion regarding the cause of death. Part I of the death certificate includes the proximal cause of death, or what directly caused the death, and Part II lists conditions that contributed to the death:

For example, if a patient dies of respiratory failure due to acute respiratory distress syndrome (ARDS), which was the result of pneumonia, which was the result of COVID-19, the proximal cause of death was the respiratory failure, but contributing causes were ARDS and COVID-19, with the one farthest up the chain being the underlying cause of death under Part I. If the patient had hypertension or asthma, that would go under Part II. As I like to say, if you suffer a cardiac arrest due to blood loss after being shot, the cardiac arrest might have been the proximal cause of death, but you still died of a gunshot wound.

A few years ago, I lost someone to a drug overdose. The cause of death was not listed as drug overdose. It was listed as cardiac arrest. Drug overdose was listed as a contributing factor, along with several other things. Using the tortured logic of the COVID denialists, I would conclude that my friend died with a drug overdose rather than of a drug overdose even though they God damned well died of a fricking drug overdose.

In short, people do not generally die of COVID-19 itself. They die of the pneumonia it causes. They die because they can’t breathe. They die because their kidneys fail. They die because their heart stops. A severe case of COVID-19 results in an assault on many bodily systems and there are many ways for the disease to kill. Really, the error here is that 6% of the death certificates listed COVID-19 as the cause of death because they really shouldn’t; they should be listing the exact path COVID-19 used to kill.

The reality of COVID-19 as a mass murderer can be seen in the cold equations of death statistics. The CDC’s data shows that something like 200,000 more Americans have died to this point in the year than die in a typical year, mostly of things like pneumonia. Yet somehow that data was missed by the Qidiots when they started conspiracy theorizing.

The less conspiratorial interpretation of the CDC’s data has been with us for some time and goeth thusly: “Well, OK, those people died of COVID-19. But they had comorbidities!³ They were old! They were obese! They had pre-existing conditions! Let’s just protect those people and the rest of us can get on with our lives!”

The role that comorbidities play in COVID-19 has never been concealed. The first evaluations out of Wuhan indicated this was a big factor. But let’s take a step back here. The biggest comorbidity for COVID-19 is hypertension. One-third of American adults have high blood pressure. And a huge part of that is genetic. There are many people out there who are watching their diets, getting exercise, avoiding salt … and they still have high blood pressure because they are genetically pre-disposed to it.⁴

You know how many Americans have pre-existing conditions? 40%. This ranges from 30% in Utah to half in West Virginia. That means 40% have a high risk of serious illness and death. And it’s not just the oldest 40%.

Even putting that aside, COVID-19 is a serious illness. There are people out there — healthy young people — still dealing with it months after their infection. The path of COVID-19 is not that you live or you die. Most people won’t die. But a huge fraction of those that survive will endure serious hospitalizations with all the stress that entails (you can read Andrew’s post on what it’s like to survive that sort of thing). A large fraction of those will have long-term health effects, health effects that will become “pre-existing conditions” if COVID-19 (or even just a bad flu) comes back for another round. Even if we are able to defeat COVID-19, “complications from COVID-19” may be listed as a contributing cause of death long for a long time afterward.

And even putting that aside, what the holy hell is being said here? That people with pre-existing conditions deserve to die? I wouldn’t say that, except we have a very long and ugly history, as a species, of saying exactly that. From biblical claims that leprosy was caused by sin to medieval claims that the Black Death was caused by witchcraft to modern claims that AIDS only killed gays and sex workers, we have a tendency to turn a blind eye to the suffering of our fellow human if we think they did something to deserve it. “You wouldn’t have died of COVID-19 if you weren’t fat” is one hell of rallying cry.

Really, this is COVID-19 denialism distilled into its utter essence. From the first week, they have been looking to minimize the problem or find a quick fix to make it go away. They tried denying it was serious, which didn’t work. They jumped on hydroxochloroquine, which didn’t work. They said the summer weather would end it, which didn’t happen. They said the only way to deal with it was herd immunity, but Americans balked at the idea of 1-2 million deaths (and it’s not clear that this would work). So now we’re back to denial with a sprinkling of herd immunity nonsense.

The simple reality is that COVID-19 is with us for the medium haul, if not the long one. As our understanding of it and our treatment courses improve, we will be able to ease off some of the restrictions. If we get a vaccine — even a weak one — that will allow us to open up a bit more. But wishful thinking and misreading CDC reports is not going to get us out of this.

I know a lot people hate the analogy of a war, but we’re in the equivalent of one. It’s going to be expensive, drawn-out, painful and messy. But we will get through it if we keep our wits about us. Misrepresenting a CDC report to claim that the virus didn’t slaughter tens of thousands of people is the opposite of that.

1. Which is saying something.
2. It was also disappointingly repeated by a couple of contributors at Reason who should frankly know better.
3. Let me just pause a moment and note that one of the weirdest things about COVID-19 is the way complex scientific concepts have entered our common lexicon.
4. And many may have undiagnosed hypertension because they don’t have insurance.