It seems like there’s discord about whether everyone who dies WITH #COVID19 should be classified as a #COVID19 death.

What I’ve observed:

If you were healthy at baseline (no diabetes, cancer, etc) AND had #COVID19 and then died...it was almost certainly from #COVID19.
Alternatively, if you had underlying health issues AND #COVID19 and subsequently died...the virus undoubtedly played a role in the overwhelming majority of those deaths.

The sad reality is our #COVID19 death toll may actually be an UNDERCOUNT - not an overcount at all!
Ideally, EVERY death would be tested - not just for statistics, but to better inform families who may have been exposed & for contact tracing.

But we‘re haunted by our earlier failures - we still don’t have enough tests to do this, months into a pandemic. https://on.wsj.com/2LtfElA 
Without confirmatory testing, it’s hard to know for certain.

However, it’s undeniable there has been an enormous spike in deaths compared to previous years especially in places like NYC.

Yes, some of these deaths may be non-COVID heart attacks etc... https://nyti.ms/2WUVPco 
But we also know that many of these deaths that occured in the community - including many that were undoubtedly caused by #COVID19 - were not classified as such.

When I think of how this could’ve been done better, I reflect on my experience in Guinea in 2014/2015.
During the Ebola outbreak in West Africa, the goal was to swab & test EVERY death. This approach largely succeeded despite the huge logistical challenges.

It gives you more accurate case numbers & death count, as well as a better understanding of how to respond to the outbreak.
But frankly, it’s hard to ignore why the @WhiteHouse Coronavirus Task Force would want to lower the overall death tally.

On March 7 at @CDCgov, @realDonaldTrump said he didn’t want to test passengers on a cruise ship because of the impact it would have on the case numbers.
“I would rather because I like the numbers being where they are...I don't need to have the numbers double because of one ship that wasn't our fault.”

Case numbers & death counts are always political.

They reflect the response’s success...or failure. https://wapo.st/2TL6eWw 
When we discuss deaths during #COVID19, we should remember a few things:

There was likely an increase in deaths from non-COVID causes - like heart attacks - because people feared going to the hospital...

AND the ‘official’ tally of #COVID19 deaths is very likely an undercount.
Lastly, we must remember that this discussion - and our decisions - mustn’t focus solely on death counts!

I know from talking with other Ebola survivors that many of us continue to live with long-term complications.

An accurate count of #COVID19 deaths is extremely important...
But many who have had this virus - over 1.3 million in the US and 4.3 million in the world - will potentially live with the long-term physical and mental scars of this disease.

All the more reason to focus all our energies on a strong local and global response.
You can follow @Craig_A_Spencer.
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