Trump once again tweeted a lie today. It was rightly taken down by twitter, but like most of his actions there is damage already done— to facts, to science, to public trust, to our ability to fight covid.

*a thread on covid, death certificates, and cause of death*

#COVID19

The circulating lie is that “only 6% of covid deaths are due to covid alone” and “only 9,000 people have actually died directly from covid”. This is a gross misrepresention of the data released by the CDC. Let me explain....

#COVID19

The CDC provided a detailed breakdown of both comorbidities and contributing factors to death. These are things that a doctor or a medical examiner list on the birth certificate as causes of death.

Here’s what the cause of death portion of a death certificate looks like:

As an emergency physician, I fill these out pretty frequently. While certainly not perfect, the idea behind it is to capture the sequence of events that lead up to a person’s death. This is much more useful (and accurate) than listing a single cause of death. Here’s the idea:

For example, if a person is car accident, they might die because of bleeding in the brain. In this case, I could write:

A. Intracranial hemorrhage
due to:

B. Blunt force trauma
due to:

C. Motor vehicle accident

Other contributing conditions: alcohol intoxication

Or, if a patient has HIV and then develops a bacterial pneumonia due to low CD4 counts and then dies, I might write:

A. Sepsis
due to:

B. PCP pneumonia
due to:

C. HIV

You can see how this is useful. First, it tells a story. The “underlying cause” is the immediate thing that causes death. But there is usually a chain of events with an initiating factor leading up to that. The patient developed pneumonia *because* of immunodeficiencyfrom HIV.

Second, it provides rich data for understanding mortality and causes of death. If I could only put ONE thing, I could write “sepsis”, but then we would miss that this patient had HIV. If I wrote “HIV” then we wouldn’t understand how people with HIV die and from what infections.

Which brings us to COVID, which we now know not only affects the respiratory system but the cardiovascular and renal systems as well (and probably more). Patients with COVID can die in a number of ways, but *all the ways are set into motion by acquiring coronavirus*

If you look at the CDC data that the false claim is based on, you will see a table with column:

“Conditions Contributing to Deaths where COVID-19 was listed on the death certificate”

This includes things like: acute respiratory distress syndrome (ARDS) and “Kidney failure”

This is what it would look like on the death certificate:

A. Acute respiratory distress syndrome
due to:

B. COVID-19
due to:

C.

Perhaps the person also had diabetes and chronic renal disease. The physician may add:

Other contributing conditions: diabetes
CKD

Clearly, it should be obvious that the person would not have developed acute respiratory distress syndrome if they did not have COVID. To suggest otherwise flies in the face of simple common sense.

#Coronavirus #COVID19

Diabetes or CKD may be listed as a *contributing condition* because it places one at increased *risk* of severe disease from COVID, but it did not *cause* the patient to get COVID. It is a modifier of, not an independent cause in, the chain of events leading to death.

Now, I’ve heard folks say “well what if a person is in a car accident and they just happen to have COVID but now it’s on the death certificate”?

I don’t have time for that nonsense. Show me the data and then we’ll chat.