Experts: viral report on COVID-19 toll flawed

Contributing conditions important, but COVID-19 killed patients
The U.S. Centers for Disease Control and Prevention in Atlanta, photographed on March 10, 2020.  The CDC's data are crucial to the COVID-19 pandemic response and are widely scrutinized. (ALYSSA POINTER/ALYSSA.POINTER@AJC.COM)



The U.S. Centers for Disease Control and Prevention in Atlanta, photographed on March 10, 2020. The CDC's data are crucial to the COVID-19 pandemic response and are widely scrutinized. (ALYSSA POINTER/ALYSSA.POINTER@AJC.COM)

A flawed news report on CDC death counts from COVID-19 whipped through social media Monday, seized on by thousands who thought the data revealed a truth they had long suspected: that nearly all people counted as dying of COVID-19 were actually sick with something else to begin with.

Only, that wasn’t the truth. Experts say the news headlines and posts attributing almost all deaths to underlying conditions were based on a faulty read of the CDC data.

That didn’t stop the social media engine. An anti-vaccination filmmaker garnered thousands of likes upon tweeting the misleading story, saying that if people were surprised, then they hadn’t been paying attention to his TV show. A Florida state representative claimed the story was blacked out by a “corrupt media.”

Texas State Senator Bob Hall, recognizing the public decisions at stake, posted, “With this announcement all of the defensive measures (masks, lockdowns, and isolations) are totally unnecessary and should end immediately!”

The CDC data can be difficult to understand. “The CDC is just kind of putting out the raw information, the raw data,” said Dr. James Gill, a clinical associate professor of medicine at Yale, and Connecticut’s chief medical examiner. “But it really does need interpretation.”

The inaccurate accounts also stemmed from overlooking how widespread chronic conditions are, and from mistakes that doctors, medical examiners and coroners make in filling out the CDC’s death forms in the first place, experts said.

Gill likened it to a victim who dies of a gunshot wound to the heart resulting in cardiac arrest, and people claiming, “‘Well there was a contributing condition, it wasn’t purely from the gunshot wound.’

“No, of course it was from the gunshot wound to the heart,” Gill said. “They’re kind of fouling up.”

A viral idea

The news stories that mischaracterized the data, mostly from television station websites and briefly online by the AJC, garnered attention across the country. The headlines said that 94% of people recorded as dead from COVID-19 had an underlying or contributing medical condition.

The stories and other accounts were based on a statement in the CDC’s weekly COVID-19 data updates. The Atlanta-based agency reported that 6% of COVID-19 death certificates listed only the virus as the cause of death.

That percentage, which has held steady, represents only around 10,000 of the more than 180,000 Americans who have died of COVID-19.

Some took that as the disease’s true toll.

One who ran with that number was a Twitter user whose profile allied with the QAnon conspiracy theory. The tweet concluded that “only 6%” of recorded COVID-19 victims “actually died from Covid.”

President Trump retweeted that post.

Twitter later deleted the original Tweet as misinformation. But Trump continued to push the theory, the Washington Post noted, retweeting an article that concluded, “So let’s get this straight — based on the recommendation of doctors Fauci and Birx the US shut down the entire economy based on 9,000 American deaths due entirely to the China coronavirus?”

Cause and effect

The CDC’s statement and its spreadsheet show something different.

The institution’s spreadsheet, it says, “shows the types of health conditions and contributing causes mentioned in conjunction with deaths involving coronavirus disease 2019 (COVID-19). For 6% of the deaths, COVID-19 was the only cause mentioned.”

The long list of conditions and contributing causes do include chronic illnesses, such as hypertension or diabetes. But they include more.

Sometimes, what some read as contributing conditions were actually the ways that COVID-19 killed a person. For example, the condition of cardiac arrest, when the heart stopped beating. Or respiratory arrest, where the lungs stopped breathing.

Those shouldn’t even be listed as causes of death, CDC officials said in a webinar, and they’re working to educate those who certify death certificates to stop writing them in that field.

Then there are conditions that are permitted to be listed as causes—but all may fall in one lethal chain of events leading to the death.

For example, COVID-19 may cause pneumonia, an infection where the person’s lungs get inflamed and may fill with fluid. That may lead to Acute Respiratory Distress Syndrome, where the person has severe difficulty breathing. Then the person may die because of completely losing the ability to breathe.

In that case the COVID-19, the pneumonia and the ARDS are all causes of death, but COVID-19 is the one that caused the others.

A population with conditions

Death certificates listing multiple causes of death also reflect the widespread existence of chronic conditions among Americans.

People with diabetes, obesity and asthma are more susceptible to the new coronavirus and may be more likely to die from it.

And they’re not a marginal slice of the country. More than 40% of Americans are obese. One-third have hypertension. Eight percent have asthma. More than 1 in 10 have diabetes.

In fact, some COVID-19 deaths were probably undercounted because they were attributed to other causes, particularly at the beginning of the pandemic when testing for the virus was not widespread, said Dr. Kathleen Toomey, Georgia’s commissioner of public health.

“This virus does masquerade as a lot of different things,” Toomey said. “And if you have underlying conditions, be it obesity or diabetes, renal disease, heart disease, you are more likely to have complications and potentially die or have long-term adverse outcomes.”

Some social media posts on the data suggested lifting public restrictions for all but those with chronic conditions. Gill demurred.

“There are vulnerable people working in post offices, in grocery stores,” he said. “You’re going to have every person who’s obese lock themselves away? You’re going to have everyone who’s got diabetes lock themselves away? Everyone who has asthma lock themselves away? Everyone who’s over 60 lock themselves away? You know, you just can’t do it.”

The CDC knew that gathering the data was key to devising the public response to the pandemic but could lead to problems. As the pandemic ramped up in April, officials there were already seeing mistakes as doctors, medical examiners and coroners, some of them overwhelmed, began filling out death certificates for COVID-19 victims. Knowing that the number of deaths in the pandemic would only increase, CDC issued instructions and held a webinar to explain.

“The completeness and accuracy of death certificate information is crucial,” the CDC’s principal deputy director, Dr. Anne Schuchat, told listeners. “But it’s complicated.”

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