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

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

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

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

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'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

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

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'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

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!

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

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

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

19/n There you have it - a simple explanation

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