We can use deaths-above-replacement (among other things) to determine how many more people died than normal from all causes, and then whittle down the obviously-not-from-contracting-covid deaths from there. The submission goes into very specific detail about how they did this, and they account for many of the potential confounders related to doing this analysis.
I believe we can be much more precise than you're giving us credit for in determining if contracting COVID was the direct cause of someone's death, even with comorbidities.
To be totally honest, when I see someone say, "we can't ever be totally sure" I nearly wholly discount that opinion, because it's very cheap to proffer, almost always true, and of very little value.
It is of immense value to say this when you have people in this very thread saying we might as well count everyone who had COVID as a death from COVID.
Also one of us is confused, and I don't think it is me. From what I've gleaned from this article, the 900,000 figure is not (as you say) "determining if contracting COVID was the direct cause of someone's death", but rather trying to figure out how many people would have died if this had been a "normal" year, i.e. if we could go to a parallel universe and make COVID never exist. This is absolutely not the same thing, as such a scenario will also count deaths as a result of our response to the virus as a death "due to the virus". This is my impression as they seem to be including things like suicide (criteria "c") and people who died because people with actual COVID were taking up hospital beds (criteria "b").
That's what he is attempting to imply is a massive overcounting in the data, but additional conditions that people point out as COVID deaths also having are mostly caused by COVID-19. Oh, they died of viral pneumonia after contracting COVID-19; pretty sure they would be in a different scenario had they not caught COVID-19.
I think it's impossible (with the current state of technology) to determine the actual cause in patients with comorbidities. The patients died _with_ coronavirus in these statistics rather than _from_ coronavirus.
Anyway, it's hard to argue with those people. But if you look at the average deaths a country has per month, and see the increase because of Covid, you should be able to infer something is wrong with just a bit of common sense.
IANAD (I am not a doctor). However, common sense tells you that "cause of death" is impossible to pin down in all cases, because you don't have the counterfactual ("if they did not have COVID, would they have died anyway?"). The official "cause of death" is quite often "congestive heart failure" but that's just the last thing that happened to them.
For that reason, "excess deaths" is about the best we can do, being an aggregate number. We don't need to decide if they died "of COVID" or "with COVID." We have a distribution of the number of deaths, there's no issue of whether someone is dead or not, and it has a mean and SD.
It's also common sense that, whatever other variables you bring in, "persons per household" is a primary variable. Sustained contact with an infected person just has to be a prime cause of the spread of a communicable disease. "Population density" is probably a weaker proxy for that.
> Is "pointing out" data considered downplaying? ~5% of deaths had "covid only" while the remaining 95% had other factors with the average having 4 other factors.
Is this a useful metric, though? If covid is the catalyst to cause death with preexisting conditions, is not covid the actual cause of death?
Covid in these cases is an acute condition that is the direct cause of death.
COVID19 doesn't even play a role until 2 or 3 lines later. Doctors write down "Killed by X" which was caused by "Y" which was caused by "Z". COVID19 is never "X", its always Y, Z, or later.
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Because we have these statistics, we can correlate "X" causes. If "X" is "blunt force trauma to the head", it is unlikely that "Y" or "Z" will be COVID19.
But don't take my word for it. There's plenty of death certificates, and such data has been coallated together.
See Table 2 in this list, as an example. You can see that the immediate cause of death for most COVID19 patients is Pneumonia, unspecified (J18.9), followed by Acute respiratory failure (J96.0).
Which of these ICD codes do you think is being misclassified as a COVID19 death? Please be specific. Any such large scale misclassification would be obviously in the data here.
Yes, and there is a good argument that such deaths are COVID-related, even though the virus itself didn’t infect the person. This is one of the reasons that “excess deaths” is a compelling measure.
Unfortunately, it is hard to get those numbers correctly. COVID patients die because of multiple organ failure and unless the deceased was already tested and verified for it, you can't attribute the death to COVID officially. A lot of people pass away without showing visible symptoms or without realizing they need immediate medical attention for COVID.
It would be good to have that attribution and that will require testing the deceased, but given the load on the system, everybody can extrapolate the scale and act accordingly.
You are making an assumption that all (or even just the majority) of excess deaths are because of this.
Moreover, we know that there are examples of the opposite: deaths where Covid was on the certificate as a contributing factor, but not the primary cause. These aren't hard to find.
An 85 year-old with congestive heart failure and late-stage cancer and Covid reflects the modal situation here. It isn't some theoretical event -- it's incredibly common.
Well sure, and that is a perfectly valid comment at the micro level. However, we can relatively clearly see that the COVID-linked death reporting is under-reported from mortality baselines.
Therefore it's highly likely that for a given death it is more likely to be incorrectly categorise as non-COVID when COVID was responsible, than to be incorrectly designated COVID.
"In the US, the “fudge factor” is 1.13, which means our best guess is that 13% more Covid deaths took place than were officially reported.
For skeptics who can’t believe that deaths were under-counted: both things probably happened. A few cases were wrongly counted, but even more people may have died of Covid at home, without ever getting diagnosed."
> This practice varied by state and tracking eventually broke out death with COVID vs death by COVID.
Which involves a somewhat subjective, error-prone decisionmaking process. Early in the pandemic, when the vast majority of hospitalizations-with-COVID were due-to-covid, it made sense to just do the simple thing and assume COVID caused all the deaths. After the death rate fell and this became extremely confounding, it became important to make this somewhat subjective decision.
(e.g. a guy rolls up with a "heart attack" and is COVID positive. Is it due to COVID? SARS-CoV-2 both causes cardiac complications directly and can reduce blood oxygenation / increase heart workload, so heart attacks are more common with COVID infection).
Years ago I used to work in this area and you should not underestimate what a difficult thing "cause of death" is. At the time we mostly worked with the initial condition which led to death. But in-between that and death could be quite a few other conditions. There are relatively few ultimate conditions. Trying to apply more than one just confuses the stats/people. But our approach had one case of "flat feet" as a real cause of death! You can't win.
That makes excess deaths valuable in the case of COVID.
But your numbers are nonsense. People who have only listed Covid as a cause shouldn't even exist because a virus alone doesn't really kill you. It needs to make some part of your body so sick that it breaks down. With Covid we know that it caused respiratory failures (which then should show up as a cause of death), heart issues, inflammation, stroke, etc.
Looking at cause of death doesn't get you any closer to assessing the mortality of this disease.
> You're incorrect to say that if anyone dies with Covid-19 that they're counted as a covid-19 death.
I'm not. In some countries they absolutely do count anyone who dies while in the possession of COVID as a COVID death, for instance Italy. " Italy’s death rate might also be higher because of how fatalities are recorded. In Italy, all those who die in hospitals with Coronavirus are included in the death counts."
“On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88% patients who have died have at least one pre-morbidity – many had two or three.” [1]
In New York they're not just counting speculative COVID deaths of anyone with respiratory illness even if they've never tested positive [2].
"A subtler issue is what to do when the patient has other serious medical conditions. If the person suffered from chronic lung disease, then became infected with the virus and died of pneumonia, the immediate or primary cause would be pneumonia as a result of COVID-19. The lung disease would be listed as a contributing condition, said Sally S. Aiken, president of the National Association of Medical Examiners." [3]
The CDC has guidance on this but it's fair to say its interpretation will vary from place to place. "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 death" -- that's pretty broad. [4]
My understanding is a few folks who committed suicide and a few who died in car accidents due to head trauma were coded as COVID, but I can't find my source on that and I assume it's pretty limited. I wasn't being literal in my earlier comment, however, and nor should this paragraph be considered as changing or doubling-down on that. I assume such cases, if they do in fact exist would be few and far between.
Hope that helps.
I also don't think it's fair to pin 100% of excess deaths entirely on COVID. We shall see, however.
Using statistical measures, you don't need to be able to point at any one person and say "air pollution killed this person".
There are obviously other correlations you need to be able to account for, but generally you can account for them.
>It is not the same as saying that someone died of covid, like stated in the article.
Interestingly, the covid death rate is largely calculated the same way. Someone doesn't have to die from acute respiratory issues caused by a covid infection in order to count, we just see that populations with high rates of covid infection also have higher rates of death. This helps also account for e.g. covid causing heart attacks which would otherwise be hard to account for.
But their original argument, that anyone with COVID gets marked as a COVID death and therefore you can't trust that statistics, feels pretty weak - there's no way that we're having a sudden surge in all those causes of death to lead to the excess mortality we're seeing. It's a big leap to assume there have been enough COVID adjacent bus accidents that we can use to in any way explain away COVID's effect on mortality.
Covid would still be implicated in that case, because its the Covid lockdowns that would have disrupted that. This is a counterfactual analysis with and without Covid, that certainly does not rule out indirect ways that Covid could have increased mortality. If anyone reads this without taking that into consideration, that's either dumb or agenda motivated, very likely both.
Its fairly straightforward. The number of deaths under a given circumstance have its natural uncertainty and fluctuation that's captured by its statistical variance. One compares the recorded deaths during Covid period against the typical number of deaths during a comparable situation, account for the natural fluctuation, what remains is the excess death that cannot be explained by natural fluctuation of these numbers.
With presence of Covid being the significant way in which the scenarios are different, it can be claimed with statistical accuracy which are the excess deaths that happened as a result of Covid, either directly or because of other factors influenced by Covid (Oxygen shortage being one such example).
That said, those close to the government and its agenda will leave no stone unturned to dispute and discredit this study. As long that's an informed, good faith and rational argument I dont mind at all. I do have serious doubts on whether majority of the disputing and discrediting will be based on good faith.
Somewhat related, on the opposite point. Elon Musk among others said the counting of deaths was manipulated upwards, with comorbidity being counted as a COVID death even when the patient had 2 or more serious health conditions already. I think there is a desire to overcount which must not be glossed over either.
he's just pointing out that nobody writes the flu as the cause of death on a death certificate. The CDC simply releases estimates, while we've been tracking the severity of COVID-19 deaths by asking clinicians to write the cause of death as COVID-19 on the death certificate if they tested positive.
Patient has flu and dies of a stroke? Flu can increase the chance of stroke by 50% but the cause of death was the stroke, not the flu. Same thing happens to covid-19? They died of covid-19.
The point is that the data collection methods are so different there's no possible way you can really look at the numbers and tell if one kills more than the other.
I believe we can be much more precise than you're giving us credit for in determining if contracting COVID was the direct cause of someone's death, even with comorbidities.
To be totally honest, when I see someone say, "we can't ever be totally sure" I nearly wholly discount that opinion, because it's very cheap to proffer, almost always true, and of very little value.
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