I am concerned by a recently-cited statistic that “94% of #COVID deaths had underlying medical conditions,” which seems to be used as “proof” that the detrimental effects of COVID are limited to a small group of people who are already "sick"...
https://bit.ly/3jvFjJj 

or even that COVID-19 may not have been the “true” cause of death. The CDC report where this originated used data from death certificates. As someone who has completed many, many death certificates, I believe I am well-positioned to clarify the meaning of this statistic.

In filling out a death certificate, doctors are asked to enter an immediate cause of death, as well as other contributing factors. In many cases, immediate cause of death was “cardiopulmonary arrest” which is the final pathway through which a majority of deaths occur.

Cardiopulmonary arrests are caused by something else, like respiratory failure. Respiratory failure may have been caused by pneumonia. All these conditions could be on a death certificate as co-existing conditions. Still, we would say this person died because of pneumonia.

COVID-19 causes pneumonia, but also causes many other conditions due its propensity to cause blood clots. Examples: clots in heart (causing heart attacks, and often heart failure), clots in brain (causing strokes), and clots in kidneys (causing renal failure).

For instance, a person who died from COVID-19 may have a death certificate that reads: “cardiac arrest” due to “heart failure” due to “ischemic heart disease” due to “COVID-19.” Another person could have a death certificate that looks like this (credit: HI Dept. of Health)

All of these conditions would be listed on the death certificate, but clearly, COVID-19, like “pneumonia” in my previous example, is what we would all consider to be the cause of death. One more example, to drive the point home...

If someone is shot and bleeds to death, their immediate cause of death may be cardiac arrest, due to hemorrhagic shock, due to a gunshot wound. We would say they were killed by a gunshot wound, not by "hemorrhagic shock." They weren't "already sick" with "hemorrhagic shock."

At certain times, doctors may include certain pre-existing conditions if they believe they predisposed an individual to develop severe COVID-19, such as obesity, hypertension, or diabetes. Still, these were not the cause of death; COVID-19 was.

Some people have looked at this CDC data and said, "Look, the vast majority of people who die from COVID-19 were already sick - they had it coming. Maybe it was even something ELSE that killed them, not COVID-19."

I fear that this CDC report is being grossly misinterpreted and used to minimize the deadly consequences of COVID-19. The official death count in the United States from COVID-19 is roughly 183,000 as I write this. In actuality, however, the total death toll is probably higher.

The primary reason we know this is because of another CDC report, which estimated the number of excess deaths that occurred since February 1, 2020 relative to what was recorded in previous years. https://bit.ly/32HnsbR 

That estimate ranges from 183,392 up to 245,305. Many people who have shared this “94 percent” statistic have used it as a rationale to argue that the death count from COVID-19 is exaggerated or overestimated. If anything, it is more likely an underestimate.

If you have made it this far, first of all: thank you, I’m flattered. Second, I hope you have started to understand what a intensely complex issue this is, and that the phrase “94% of people who died from COVID-19 had other conditions” does not capture the meaning CDC report.

Third, and most importantly, COVID-19 is something that should frighten us all. As someone who has cared for many, many patients with COVID-19, some of whom have died, I cannot underscore this enough.

Trust me, I’d love to deny or belittle #COVID's existence, to relegate it to a pile of “small problems” with a few cleverly-crafted statistics. But I can’t – none of us can.