Dying of, or dying with #covid19 ?

Alternative title:

US Death Certificates For Dummies

First, here's a snippet of a certificate (source: https://www.cdc.gov/nchs/data/dvs/DEATH11-03final-acc.pdf)

1/N

Box 32 of the certificate is filled out by the medical certifier. They are responsible for providing their best medical opinion about the cause of death.

Part I lists what DIRECTLY caused the death.
Part II lists other significant conditions that CONTRIBUTED to the death.

2/N

Part I lists a single UNDERLYING cause, which lead to another cause, which lead to another cause, and so on, until the final cause which immediately caused the death.

Part II may list zero or more additional CONTRIBUTING causes. Sometimes called "multiple causes".

3/N

Example #1: if covid is the UNDERLYING cause, and leads to pneumonia, which leads to cardiac arrest, which leads to death:

Part I:
Line c (UNDERLYING cause): covid
Line b (other cause): pneumonia
Line a (immediate cause): cardiac arrest

Part II (contributing): empty

4/N

Example #2: pedestrian with covid dies after being hit by a bus; the certificate may look like:

Part I: UNDERLYING cause: head trauma
Part II: empty

Covid will NOT be listed anywhere because it did NOT contribute to the death (see also MSDH: https://msdh.ms.gov/msdhsite/_static/14,22075,420,694.html)

5/N

Example #3: someone with life-threatening asthma & severe covid dies after breathing problems (unclear why). The certifier MUST choose a single underlying cause and list the other in part II:

Part I: UNDERLYING cause: asthma
Part II: CONTRIBUTING cause: covid, or vice versa

6/N

Bottom line, regardless of where covid is listed on the certificate—underlying (part I) or contributing (part II)—it was a CAUSE of death.

Ergo, people die of covid, not with covid.

But wait, there is more...

7/N

As per https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm when covid is listed on the death certificate:

95% of the time it's the UNDERLYING cause (part I)

5% of the time it's a CONTRIBUTING cause (part II)

So medical certifiers believe covid to be the primary cause of death in 95% of cases.

8/N

Of course certifiers are humans—sometimes errors happen

They may erroneously list covid as a contributing cause (part II) just because the person tested positive

It happens

But it's NOT standard practice

MSDH specifically warns against this error: https://msdh.ms.gov/msdhsite/_static/14,22075,420,694.html

9/N

If the above error is so frequent that half the time covid is improperly listed as a contributing cause, in the end it would only inflate total covid deaths by 2.5% (because covid is listed in part II 5% of the time)

Ergo: >95% of covid victims died of it, not with it

10/N

Data changes over time, and
@PRider1980 (thanks!) confirmed that currently exactly 92% of covid death certificates list "covid" as the single UNDERLYING cause that directly lead to death

(There can only be one UNDERLYING cause)

11/N https://mobile.twitter.com/12FreeBeer/status/1291811960091299842

It seems @12FreeBeer protected his tweets

Anyway, see: https://data.cdc.gov/NCHS/Weekly-Counts-of-Deaths-by-State-and-Select-Causes/muzy-jte6

Rows where Jurisdiction of Occurrence = United States:

COVID-19 (U071, Underlying Cause of Death) = 130,819 deaths

COVID-19 (U071, Multiple Cause of Death) = 141,679 deaths

→ ratio is 92.3%

12/N