The thing that nobody is talking about with regard to Covid deaths is that our data about who has died is going to lag by weeks, months or even years and will probably fail to represent all of the deaths for which Covid is responsible. Why is this?
- People are dying at home of Covid. How do I know this? Because 25% of people die in their own homes. People with symptoms of coronavirus are being encouraged to stay at home so some proportion of them, likely older or with disabling diseases, are dying there. When a person dies at home, unless it is a hospice death, the process of certifying their cause of death can be quite prolonged. Sometimes a coroner is involved and it can take weeks.
- It takes a long time to die of an acute disease in the hospital. We work really hard to keep a patient alive who has been intubated and admitted to the ICU. We will try all sorts of procedures to make the lungs work and, even as the lungs get worse, we still find new machines or drugs to keep them alive with the hope that, if they survive long enough, their lungs will heal. Some of the patients in New York hospitals who are on death's door will remain there for weeks until either their bodies or their families finally give up. It could take weeks after coronavirus infections start to peak to know what percent of those infected people will die of the disease.
- Doctors working with patients who are dying are very tired, and one of the least pressing things on their to-do list is to fill out death certificates. Some of that documentation is waiting in an exhausted physician's in-box to be completed.
- In the busiest hospitals and most infected communities, patients with definite Covid-19 aren't being tested because there is no time and it becomes clear what is wrong with them because of their symptoms. When doctors fill out death certificates they may not list Covid-19 as the cause of death. I just recently got an email from the Idaho Death Registry telling me to put Covid as the cause of death if this is my educated opinion, even if the patient wasn't tested. It is likely that many physicians don't know this is the correct way to do it.