There’s a stunningly wrong statistic being passed around, saying that the CDC “admitted” that only 6% of documented COVID-19 deaths were actually from the virus. This is wrong, and is the kind of thing that you can only conclude if you don’t know how death certificates work. The deaths were all from COVID, and about 95% of them had the coronavirus as the original cause of illness.
You see, death certificates list an immediate cause of death, and then they also allow the doctor to note underlying causes of death. Here is what the standard US certificate of death looks like, straight off the CDC website.
The portion of the U.S. Standard Certificate of Death where immediate and underlying causes are listedScreenshot: CDC (Fair Use)You see, there is no checkbox for whether or not someone had COVID-19 at the time of death. The person who fills out the form must say what was the immediate cause of death, and can then list a chain of events, if applicable, explaining what led to that. The instructions for the form include examples like this one:
If an organ system failure such as congestive heart failure, hepatic failure, renal failure, or respiratory failure is listed as a cause of death, always report its etiology on the line(s) beneath it (for example, renal failure due to Type I diabetes mellitus).
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The pathway from disease to death can be complex, as you know if you’ve ever lost a loved one who had health issues at the end. The person may check into the hospital for one reason, and end up technically dying of a complication of a complication of that original thing.
COVID-19 deaths are often like this. For example, a person may develop adult respiratory distress syndrome (ARDS) as a complication of a COVID-19 infection. If they die of ARDS, that will be listed on the death certificate, with COVID-19 as the underlying cause.
We can tell from the death certificate whether COVID was the immediate or underlying cause
The myth that’s being passed around goes like this: In many of the documented COVID-19 deaths, a person had something else that got them really sick in the first place and sent them on the road toward dying. Somewhere along the way, they got COVID-19, and so COVID-19 ended up on the death certificate even though it wasn’t “really” the cause of death.
Good news! We can tell the difference between this and the above scenario by looking at where COVID-19 is listed on the death certificate.
If a person was very sick with something else, say cancer, and then as a result of that condition they couldn’t recover from a case of COVID-19 that they contracted, COVID-19 would be listed as the immediate cause on the first line, and the cancer would be the primary underlying cause. If a person contracted COVID-19, and died of complications from it, COVID-19 would be the primary underlying cause (the last one in the list), and something else, like respiratory failure, would be on the first line as the immediate cause.How many people died of COVID-19 versus with COVID-19?
First, let’s look at where the 6% number comes from. Here is the CDC website that lists COVID-19 deaths by comorbidities. It has a note that “For 6% of the deaths, COVID-19 was the only cause mentioned.”
If COVID-19 was the only cause, that means the person had nothing wrong with them beforehand, and that they didn’t develop any complications of COVID-19 before dying. As you might expect, that’s rare. COVID patients tend to have a long, difficult illness, and may be in intensive care for weeks. Complications caused by COVID-19 are common.
So here is the important number: the CDC explains that “For the majority of deaths where COVID-19 is reported on the death certificate (approximately 95%), COVID-19 is selected as the underlying cause of death.”
This means that when COVID-19 is on the death certificate somewhere, nearly all the time it is the underlying cause of death.
They all died of COVID-19, though
Here’s where we get into the mental gymnastics, though. If somebody got COVID and died of complications that followed, clearly they died of COVID. But if somebody was already very sick, and then got COVID and died...well, they still died of COVID, didn’t they? The logic of saying that shouldn’t count as a COVID death is like saying if you had cancer and got hit by a bus, the bus didn’t really kill you.
One version of this “6%” meme implies that many of the deaths shouldn’t be counted because “old age” was a factor. By that logic, do old people just...not die? If you’re old and die of a disease, the disease still killed you. You don’t see people arguing that cancer death numbers are wrong because we need to subtract everybody who was elderly when they died.
The truth is, there’s no big conspiracy to miscalculate or overcount COVID-19 deaths. (And for those who think the CDC is miscounting: why are you citing numbers from the CDC to dispute the numbers from the CDC?) If anything, we are undercounting COVID-19 deaths. You can see this clearly by looking at how many people died this year versus in previous years. Something has killed an extra 200,000 Americans this year, and it’s not exactly a secret what’s special about 2020.
