This seems to be a very commonly misunderstood point, and while I explain in my blog post I thought I& #39;d also do a tweetorial to explain:

WHY MOST COVID-19 DEATHS ARE CAUSED BY COVID-19 1/n https://twitter.com/Adam_Creighton/status/1300732710663544833">https://twitter.com/Adam_Crei...
2/n To explain, I& #39;m going to be using an analogy

Let& #39;s look at the case of the 50 y/o man with diabetes who is hit by a car
3/n So, our 50 y/o man - let& #39;s call him Greg - is walking down the street

Greg has a life expectancy of ~25 years. That means that, on average, we expect him to live until the ripe old age of 75
4/n This is, of course, terrible - without diabetes, he& #39;d live another ~6 years on average

Still, he& #39;s not on deaths& #39; door by any means

Until he tries to cross the road, and is hit by a car
5/n Greg is rushed to hospital, where despite the best efforts of the surgical team he has a cardiac arrest and dies on the table

Now, we have to answer the question: what killed Greg?
6/n The first piece of the puzzle is diabetes. In this scenario, let& #39;s say that having diabetes doubles your risk of death if you& #39;re hit by a car

For every 1,000 people without diabetes hit by cars, 5 die. With diabetes, that goes up to 10
7/n So, first time - what killed Greg?
8/n While we wait for some votes, I& #39;ll explain how death reporting works in the US (and most other places)

You first have the IMMEDIATE cause of death. Then the UNDERLYING cause, and finally COMORBIDITIES
9/n The IMMEDIATE cause of death is the thing that ultimately killed someone - they stopped breathing, their kidneys shut down, their liver gave out

The UNDERLYING cause is the thing that caused the IMMEDIATE one - cancer, diabetes, alcoholism
10/n COMORBIDITIES are the things that may have contributed to the IMMEDIATE cause or the UNDERLYING one, but aren& #39;t necessarily related directly to the death
11/n Coming back to Greg, most people are correctly identifying that he died because of the car. This seems obvious - without the car, he& #39;d have another 25 years to go!

The car is the UNDERLYING cause of death
12/n So what does that make the diabetes?
13/n Thing is, we can& #39;t entirely ignore comorbidities. We know that the diabetes, in this case, played a role in Greg& #39;s death

Remember, for every 1,000 people with diabetes who get hit by cars, an extra 5 die that wouldn& #39;t if not for the diabetes!
14/n So, we still classify diabetes as a comorbidity, because it& #39;s important, but it& #39;s clearly not the thing that actually killed Greg
15/n Now for the big/very obvious reveal - the car is COVID-19

A 50-year-old man has a risk of about 2 in 1,000 of dying from COVID-19. For the sake of argument, let& #39;s say that doubles to 4 in 1,000 if he has diabetes
16/n Thing is, his risk may be reduced by 0.2% if there& #39;s no diabetes, but it& #39;s reduced BY 100% if there& #39;s no COVID-19
17/n We can see this quite clearly in the US excess mortality figures

There are about 200,000 people who WOULD BE ALIVE TODAY if not for COVID-19
18/n Moreover, if you look at the CDC& #39;s reports, >95% of COVID-19 certified deaths had COVID-19 as the UNDERLYING (remember, main) cause of death

In other words, COVID-19 was behind MOST IF NOT ALL of these deaths
19/n There you have it - a simple explanation

As I said, MOST COVID-19 DEATHS ARE CAUSED BY COVID-19. Fin
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