By Theodore Shoebat

In the midst of the covid crisis, with hundreds of thousands of people wiped out, there is a cacophony of complaints that the counting for coronavirus deaths is part of a conspiracy and that the numbers are being overcounted.

One of the comments regarding coronavirus is that the death numbers are inflated, and they use as evidence the fact that death certificates will list the immediate cause of death while attributing it to covid-19. Such an argument ignores the reality of how death certificates are written.  Federal guidance specifies: “COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to the death.” Death certificates can be signed by a physician who was responsible for the deceased, or by coroners or medical examiners who work for counties of cities. If a patient dies in a hospital, then it would be a doctor who would sign the death certificate. But if someone dies at home, then the death certificate would be likely signed by a coroner or medical examiner. Home deaths have been being counted later than hospital deaths due to the longer process of determining the cause since the victim never sought treatment or got tested, as opposed to a hospital death where the patient has been tested and the condition was known. Numerous cities like New York had spikes of covid deaths in homes, due to these people not being tested or treated, and so it takes time to count these deaths. The full completion of death certificates can take a long time due to the process of determining a cause of death.

If the person had heart disease, diabetes or high blood pressure and got covid, the coronavirus  exasperates the pre-existing condition and thus indirectly kills the person. “Without the COVID19 being the last straw or the thing that led to the chain of events that led to death, they probably wouldn’t have died,” said Sally Aiken. Dr. Thomas Gilson, Medical Examiner for Cuyahoga County in Ohio, explained that when coronavirus causes pneumonia or exasperates a pre-existing condition that kills the person, this is counted as a covid death:

“There’s people who die very obviously from coronavirus… It’s a respiratory infection, and if someone has pneumonia and they’re COVID-19 positive, well, that’s a very obvious death related to coronavirus. …Many of the people who have passed away have underlying illnesses …So, if someone had COPD (chronic obstructive pulmonary disease), for example, they already have a compromised respiratory function and many people will die from COPD. But the coronavirus certainly is not a help in any of those situations. These are associated deaths.” 

There is also the reality of coronavirus killing young people with blood clots. While the clot was the immediate cause of death, coronavirus has to be specified as a direct link to the death. As Scientific America reports:

“Another complication for assigning a cause of death for COVID-19 is that some younger people have died of strokes and heart attacks and then tested positive for COVID-19 without any history of respiratory symptoms. The virus is now known to cause blood clots, suggesting that COVID-19 was the killer in these cases, too. Fowkes and her colleagues conducted a microscopic inspection of the brains of 20 COVID-19 victims in her hospital system and found that six of them contained tiny blood clots that had caused small strokes before death.”

People will argue that since death certificates blame the death on covid while at the same time saying that the person died from something else, this means that there is an overcounting of covid deaths. For example, conservative commentator Candace Owens wrote that “if you die from heart disease right now, and they determine you to be an asymptomatic carrier of COVID-19 in your post-Mortem, they legally add your death to the #Coronavirus death toll”. 

For one, most tests aren’t for people who are asymptomatic. Many regions in the have limited testing for those who are suffering from the symptoms. Moreover, people who are not suffering from covid symptoms are more than likely not to get tested, and they aren’t going to a hospital because, due to the absence of symptoms, they don’t feel the need to. Meanwhile, these asymptomatic people are the biggest spreaders. Also, if someone dies from a stroke or a heart attack and they were asymptomatic, it is unlikely that they would be tested for coronavirus when covid symptoms were not killing them. According to Dr. Aiken:

“Sometimes it isn’t clear how various things relate to one another at death …Certain judgments will be wrong. In the example given, (stroke with COVID-19), it would be important to know if that individual had symptoms of COVID-19. If so, symptoms such as dehydration from COVID-19, or inability to take medications for blood pressure control, may put that person at risk for a stroke. In that case, the cause of death might be listed as ‘stroke,’ but COVID-19 could be contributory. There is also emerging evidence that COVID-19 infection may have unexpected effects on blood vessels, and circulation, making infected people susceptible to stroke.” She added that a lack of testing can also be due to a lack of funding depending on the county, and also stated: “medical examiners and coroners are not part of a conspiracy of death certification to classify all deaths as caused by COVID-19. We are certifying deaths to our best knowledge and belief, based on investigation, medical information, and testing, as always.”

Another claim that has gone viral on the internet is that anytime someone who tests positive for covid dies, this person is automatically counted as a covid death. People are referencing this claim to prove that the death toll is inflated. In fact, this claim is being stretched to the point where its being said that “the state” has instructed that “anyone who didn’t die by a gun shot wound or car accident” be listed as a coronavirus victim. But the claim is not accurate. It is true that several suicides, homicides and overdoses were counted as covid-19 deaths. For example, in Washington there were seven deaths that were wrongly attributed to covid, but these deaths were removed from the coronavirus death count as we read in Q13 Fox:

“Washington health officials on Wednesday removed seven deaths from the state’s official COVID-19 mortality count, including three homicides.

The Department of Health said it had been counting as coronavirus deaths all people who died and tested positive for the disease. Authorities say they have now removed deaths from the count that weren’t caused specifically by COVID-19.

Those deaths included three homicides, two suicides and two overdoses. The department osaid four of the deaths were in King County and three were in Yakima County.

Going forward, authorities say they will attempt to be more specific about whether a death was caused by the coronavirus or whether a person died of other causes.”

Of course, it is faulty and wrong to include such instances to the covid death counts. But this is due to the system of quick counting that the government utilizes in order to have a basic idea of the seriousness of the virus’s spread. The reason for this quick blaming of coronavirus is not to inflate numbers, but to give a general forecast of the severity of the pandemic. As we read in an article from the Coloradoan:

“In the U.S., COVID-19 is a “notifiable disease” — doctors, coroners, hospitals and nursing homes must report when encountering someone who tests positive for the infection, and when a person who is known to have the virus dies. That provides a nearly real-time surveillance system for health officials to gauge where and to what extent outbreaks are happening. But it’s a system designed for speed over accuracy; it will invariably include deaths not caused by the virus as well as miss deaths that were.

For example, a person diagnosed with COVID-19 who dies in a car accident could be included in the data. But someone who dies of COVID-19 at home might be missed if they were never tested. Nonetheless, the numbers are close enough to serve as an early-warning system.”

But there is definitely a process behind determining what a death certificate says. The system in its totality — while of course having cracks and faults — has a methodology and does not emphatically require an immediate counting of a certain death as a covid death. Those who died while suffering covid symptoms, but had a pre-existing condition, could be listed as a “probable” covid death and thus included into the death count in order to have a basic coronavirus forecast. Nonetheless, there is definitely a methodology of determining a covid death. The system is not just a complete arbitrary apparatus that is inflating the numbers. As Sally Aiken, the president of the National Association of Medical Examiners, explains: “Medical Examiners and Coroners certify hundreds to thousands of deaths each year, using investigation, autopsies, and medical tests as required, and do not choose a ‘default diagnosis’ such as COVID-19.” Dr. Heidi Gullett, Cuyahoga County Board of Health Medical Director, emphasized that each counted death is determined by lab testing, not some arbitrary default system of automatically blaming covid:

“we actually go back and verify the lab that confirms the person was positive for COVID-19 … So when I present the fatality data every Friday, and you see the daily numbers on our website, each of those that are listed under lab-confirmed are somebody who died of COVID-19 infection-related complications. So they all have lab confirmed deaths. … It’s a serious disease. Thousands of people in our country have died of COVID-19. I don’t think that’s an overestimate, and I don’t think that’s anything that we can treat lightly.”

In fact, the CDC does not allow for the blaming of covid when the death obviously was not caused by the virus:

“When COVID-19 is reported as a cause of death on the death certificate, it is coded and counted as a death due to COVID-19. COVID-19 should not be reported on the death certificate if it did not cause or contribute to the death.”

The CDC does not order that every death be listed as a covid death, but that coronavirus should be attributed to the death when its symptoms had a direct link to the person’s passing away. As the CDC guidelines state:

“If COVID–19 played a role in the death, this condition should be specified on the death certificate. In many cases, it is likely that it will be the [underlying cause of death], as it can lead to various life-threatening conditions, such as pneumonia and acute respiratory distress syndrome (ARDS) … In these cases, COVID-19 should be reported on the lowest line used in Part I with the other conditions to which it gave rise listed on the lines above it.”

States have added to the death toll after further investigations on numerous deaths. For example For instance, in April in New York City, officials reported 3,778 deaths as “probable”, since doctors were certain enough of the cause of death to list it on the death certificate. They also add 6,589 deaths since they were confirmed by lab tests. The change NYC’s accounting of deaths was made in order to also account for deaths that took place in homes since many people died before seeking treatment or even getting tested.

Now, one will argue that these “probable” cases should not be counted and that doing so is inflating the numbers. But, the reality is that not enough states are counting probable covid deaths. Only less than half of the US states have been following federal recommendations to count probable covid deaths, according to the Washington Post:

“Fewer than half the states are following federal recommendations to report probable coronavirus cases and deaths, marking what experts say is an unusual break with public health practices that leads to inconsistent data collection and undercounts of the disease’s impact.

A Washington Post review found that the states not disclosing probable cases and deaths include some of the largest: California, Florida, North Carolina and New York. That is one reason government officials and public health experts say the virus’s true toll is above the U.S. tally as of Sunday of about 1.9 million coronavirus cases and 109,000 deaths — benchmarks that shape policymaking and public opinion on the pandemic.”

The purpose of counting probable covid deaths is to quickly register a rough estimate of the severity of the pandemic in order to inform public health decision-making.

If covid deaths are being inflated, then why didn’t they immediately inflate the numbers in Colorado when over a thousand more people in the state died the April of 2020 than in the April of 2019 and only a fraction of that increase was blamed on coronavirus? The key word here is immediately, since these excess deaths could be counted as covid deaths eventually; the point is that they did not do so immediately, but must determine — through a process and a set of procedures — the cause of death. Why didn’t they take advantage of that one thousand plus deaths if there was such a huge conspiracy to count any death they can to covid? In 2019, 6,761 people died during March and April in Colorado. In 2020, that number increased by 17% with a total of 8,190 Coloradans dying in March and April. But, only 696 people in those months were recorded as having died from COVID-19. If there was such a conspiracy to count as many deaths as quickly and arbitrarily as possible as covid deaths, then why not take advantage of such an excess of deaths to inflate the numbers?

What these excess deaths mean, in the words of the Colorado Sun, is that “there are still hundreds of additional “excess deaths” — deaths over and above what would be expected based on historical averages — in March and April that have not been attributed to the pandemic, at least yet.” These excess death were, in May, classified under “other.” But, as the causes for these deaths are determined, the number of deaths listed as “other” declines. What this means is that there is an actual system of determining deaths, and thus covid deaths are counted by this process and not by some whimsical conspiracy. “It always cracks me up,” said Sally Aiken. “Medical examiners and coroners aren’t organized enough to have a conspiracy.”

Investigations for deaths take weeks to complete and death certificates can take even longer. Dr. Kelly Lear, who has been the Arapahoe County coroner since June 2014, expressed her frustration: “I’ve got cases from March that the death certificates still aren’t done by the treating physician”. Lear also noted that her death count is over that of the health department because the latter takes longer to add up the numbers. “If you look at the health department’s numbers for fatalities, it’s different from my case count, just because they haven’t caught up yet,” she added. “I give them my information and then they have to kind of do their own tracking. But without my information, it would be even further behind.”

So what we see is not a conspiracy, but the results of a slow process of counting deaths and different procedures between government departments. We must also factor in the reality of the unknown in such a dire situation. As Steven Castro, the operations manager at the Denver Office of the Medical Examiner, stated: “We really don’t know right now what’s going on … I really wish I could say what’s trending right now. But I can’t.”

Also, not all counties are seeing increases. For example, the coroners in Mesa and Adams counties said they haven’t seen increases. But it was reported that the coroner in Morgan County ordered a refrigerated truck to handle the sudden influx of bodies. There is also the issue of death investigations. Many deaths in general are not investigated by coroners. Common deaths in hospitals — which account for many covid deaths since they are caused by typical respiratory problems — are not required to be looked at by coroners. “It’s frustrating,” Dr. Kelly Lear said. “Every county does things differently as far as the coroners go. And there is no uniformity in what each county is doing.”

There is also the issue of autopsies which are, generally, not done a whole lot. Even before coronavirus exploded onto the United States, autopsy rates were low. For example, at Mount Sinai hospital in New York City, where autopsies are free, the autopsy rate was at around 20% prior to the covid crisis. According to NAME, there is a huge shortage of forensic pathologists employed in the United States, with only 500 currently employed and 1,200 needed. Moreover, we must factor in that doing autopsies on corpses infected with coronavirus is very dangerous, and with shortages in protective equipment, this makes such an endeavor more volatile.

While people remonstrance about covid deaths being “inflated,” there is much to suggest that they are being undercounted. In the words of Dr. Aiken:  “I don’t believe that all deaths caused by COVID-19 are being counted, and I don’t believe that accurate counting will happen in the short-term future”. Katie Hutchinson, the health department’s health statistics manager for the State of Washington (where coronavirus was first found in the US), also agrees that we are undercounting covid deaths: “We suspect that we are actually more likely to be undercounting deaths than overcounting them”. CDC spokeswoman Kristen Nordlund also concurs: “In pandemic circumstances, such as with covid-19, collecting complete information on each case is challenging … The current case and deaths counts reported to CDC are likely an undercount.”

“A lot of people are dying at home. Poor people are dying at home. Homeless people are dying,” said Hilda Solis, a former U.S. labor secretary under President Barack Obama. “I do believe covid-19 is being underreported and that we need to take more responsibility.”

As a recent article from Scientific America states:

“The reality is that assigning a cause of death is not always straightforward, even pre-pandemic, and a patchwork of local rules and regulations makes getting valid national data challenging. However, data on excess deaths in the United States over the past several months suggest that COVID-19 deaths are probably being undercounted rather than overcounted. …  Excess mortality is deaths above and beyond what would normally be expected in a given population in a given year. CDC data shows a spike of excess mortality in early 2020, adding up to tens of thousands of deaths.

Some argue that many of these excess deaths are related to COVID-19 lockdowns, not COVID-19 themselves, Faust said, because people fear catching the disease if they go to the hospital for other reasons. A study in the Journal of the American College of Cardiology did find that nine major hospitals saw a 38% drop in emergency visits for a particular kind of heart attack in March. That suggests that people really are delaying or avoiding medical care, which could mean that some of them die of preventable causes.

But non-COVID conditions probably don’t explain most excess deaths, Faust said. Only a portion of heart attack visits would have represented lives saved, he said, because doctors must treat perhaps 10 patients to save one life. And other causes of death—such as motor vehicle accidents—are down.

This could change with time, Faust cautioned. For example, if cancer patients forego their treatments for a year, rather than a few months, the impact on their death rates is much more likely to be noticeable in the population-wide data. But for now, he said, “it’s unlikely that the coronavirus deaths are being overcounted by a magnitude that explains our observation that something very unusual is going on.””

One can also look at whats been happening in Brazil to see an undercount in covid deaths. So far there have been over a million confirmed covid cases and 50,000 deaths, but at the same time there has been a lack of testing. To quote top WHO emergencies expert Mike Ryan: “That generally means there are probably more cases out there than reported”.

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