Skip to main content

People still aren't getting it: Death counts from Covid 19 underestimate actual numbers!

I have recently become aware that some people are mistakenly getting suspicious that Covid 19 death counts are an overestimate. That is probably because the numbers are awful and very hard to visualize. Nearly 110,000 deaths have been documented so far in the US, which is undoubtedly significantly below the actual number who have died from the disease (see my previous blog on the subject, from very early on in the pandemic.)

Our freshman US representative in Idaho, who serves a dark red district of a very conservative state, recently wrote a letter to the CDC concerned that the guidance they have given regarding filling in death certificates will lead to a falsely elevated number of people who have died of the disease. I just wrote Mr. Fulcher a letter explaining why this is wrong.

"I saw your letter in your recent email encouraging the CDC to count Covid deaths accurately. I think you may not know some of the nitty gritty of documenting cause of death from a doctor's standpoint. After over 30 years of completing death certificates for patients who die in hospitals, nursing homes and their own homes, I have some familiarity with this. The bottom line is that, when we finally have all the data, our present estimates of deaths due to Covid 19 will be a gross underestimate.

The reasons for this are:

1. 20% of people die at home. For most of these, there is no autopsy and a cause of death is assumed to be something on their known problem list, such as heart attack or stroke or COPD or cancer. Most people who die at home with Covid don't get coronavirus testing and so won't be counted as Covid deaths.
2. From knowing what is happening in nursing homes that are infected with Covid 19, death from that disease looks like this: residents start getting fevers and coughs. They stop eating and getting out of bed. They die. It's often the increase in deaths that clues people in that there is Covid in the nursing home. So most of those people who died from Covid won't have been tested and won't have it on their death certificates.
3. In hospitals for months there was not enough testing kits to go around so when there was clearly an epidemic going on they stopped testing patients with obvious Covid symptoms. Everyone with cough and low oxygen levels had Covid 19. There was no point wasting testing and exposing nurses to more risk of infection by swabbing patients. Doctors don't necessarily feel comfortable documenting those deaths as Covid if they didn't get testing. Many of these were misclassified.

Also--you are asking the CDC to call Covid deaths only if the person died directly of Covid. This is the thing about the comorbidities. When a person has Covid and comorbidities they die of the combination. They wouldn't have died without the Covid, so it is the cause of death. Or at least should be. Some of these patients are being classified as having died due to the heart attack or the COPD exacerbation caused by Covid so they aren't on the official count.

It generally takes a couple of years for the accurate numbers of influenza deaths to get counted by the CDC because they look at more than just the death certificates. With influenza also, most deaths are in patients with comorbidities and if we just counted the ones that said "influenza" on the death certificate it would be a gross underestimate.

Right now we are trying to evaluate the impact on deaths due to Covid by looking at death rates now vs in previous years. That will underestimate the numbers of Covid deaths as well because with lockdown people didn't go out and get killed in car accidents, they didn't mix with others and die of other infectious diseases and they didn't suffer other trauma as much. So without Covid we would have been much healthier in lockdown. 

I would encourage you not to worry about the death count from Covid being inaccurately high. The CDC is really good at figuring this stuff out having done it for years with influenza. What you are seeing is falsely low numbers because that is the best we can do right now."

Just thought I would share. 

What I didn't mention to Mr. Fulcher, who in my one experience of him, at a town hall meeting, would not be very interested, is that death rates in the developing world are likely even less accurate than our own. In Tanzania, for instance, they have decided that people will be happier if they don't know what is happening with Covid 19, so after initially testing a few people they have stopped. In Brazil, they are reporting 35,000 deaths so far with over 600,000 cases. But 20% of Brazilians live in poverty and so probably die without receiving medical care. In many developing countries it may be years before there is a way to estimate the numbers of infections and deaths. India, which has very advanced medical care for those who can access it, also has huge numbers of people living in extreme poverty, many of them in crowded conditions with multigenerational families. Over 80% of Indians die at home. I'm not sure how they can accurately document causes of death there.

Much like the influenza pandemic of 1918-1919, we will not know the accurate numbers for many years. And like that influenza outbreak, we are far from being done with coronavirus in June of 2020.


Popular posts from this blog

How to make your own ultrasound gel (which is also sterile and edible and environmentally friendly) **UPDATED--NEW RECIPE**

I have been doing lots of bedside ultrasound lately and realized how useful it would be in areas far off the beaten track like Haiti, for instance. With a bedside ultrasound (mine fits in my pocket) I could diagnose heart disease, kidney and gallbladder problems, various cancers as well as lung and intestinal diseases. Then I realized that I would have to take a whole bunch of ultrasound gel with me which would mean that I would have to check luggage, which is a real pain when traveling light to a place where luggage disappears. I heard that you can use water, or spit, in a pinch, or even lotion, though oil based coupling media apparently break down the surface of the transducer. Or, of course, you can just use ultrasound gel.

Ultrasound requires an aqueous interface between the transducer and the skin or else all you see is black. Ultrasound gel is a clear goo, looks like hair gel or aloe vera, and is made by several companies out of various combinations of propylene glycol, glyceri…

Actinic Keratoses and Carac (fluorouracil) cream: why is this so expensive?

First, a disclaimer: I don't know why Carac (0.5% flourouracil cream) is so expensive. I will speculate, though, at the very end of this blog.

Sun and the skin: what happens
If a person reaches a certain age, has very little pigment in her skin, and has spent lots of time in the sun, bad stuff happens. The ultraviolet radiation of the sun does all kinds of great things: it makes us happy, causes us to synthesize vitamin D which strengthens our bones and it gives us this healthy glow until we get old and wrinkled and leathery. And even that can be charming. The skin cells put up with this remarkably well for a long time, partly aided by melanin pigment which absorbs the radiation, which is why we tan and freckle, if we are fair skinned. Eventually, though, we absorb enough radiation that it injures the skin and produces cells which multiply oddly. It also damages the skin's elasticity which creates wrinkles.

The cells which reproduce in odd ways peel, creating dry skin or dry s…

Covid 19--How the novel coronavirus will change everything

Not yet facing the emotionally draining horror of working to take care of people in a system that is overwhelmed, I am full of ideas. I am fascinated with the way the response to this global pandemic has transformed pretty much everything. People are willing to do very difficult things and large, slow systems are speeding up their processes to try to mitigate this disease's bad effects. Could have been faster, but that's in the category of regrets for which we have no time.

The first cases of acute respiratory distress syndrome from a novel coronavirus were in Wuhan, China in December 2019. At first they were thought to be SARS (another coronavirus with a different scary history). By the beginning of January the virus was characterized and found to be a different respiratory virus. It was called SARS-CoV-2 (I think that is an acronym for "severe acute respiratory syndrome coronavirus-2"--sort of like Terminator-2. Except that there were nearly 18 years between the o…