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This seems to be a very commonly misunderstood point, and while I explain in my blog post I thought I'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
WHY MOST COVID-19 DEATHS ARE CAUSED BY COVID-19 1/n https://twitter.com/Adam_Creighton/status/1300732710663544833
2/n To explain, I'm going to be using an analogy
Let's look at the case of the 50 y/o man with diabetes who is hit by a car
Let'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'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
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'd live another ~6 years on average
Still, he's not on deaths' door by any means
Until he tries to cross the road, and is hit by a car
Still, he's not on deaths' 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?
Now, we have to answer the question: what killed Greg?
6/n The first piece of the puzzle is diabetes. In this scenario, let's say that having diabetes doubles your risk of death if you're hit by a car
For every 1,000 people without diabetes hit by cars, 5 die. With diabetes, that goes up to 10
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'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
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
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'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'd have another 25 years to go!
The car is the UNDERLYING cause of death
The car is the UNDERLYING cause of death
12/n So what does that make the diabetes?
13/n Thing is, we can't entirely ignore comorbidities. We know that the diabetes, in this case, played a role in Greg's death
Remember, for every 1,000 people with diabetes who get hit by cars, an extra 5 die that wouldn't if not for the diabetes!
Remember, for every 1,000 people with diabetes who get hit by cars, an extra 5 die that wouldn't if not for the diabetes!
14/n So, we still classify diabetes as a comorbidity, because it's important, but it'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's say that doubles to 4 in 1,000 if he has diabetes
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'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's no diabetes, but it's reduced BY 100% if there'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
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'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
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
As I said, MOST COVID-19 DEATHS ARE CAUSED BY COVID-19. Fin
