USA TODAY International Edition
Why ‘ COVID- 19 killed only 6%’ is wrong
If anything, virus deaths are being undercounted
A 70- year- old grandfather of three arrives at the hospital in respiratory distress. He has struggled with heart disease for years and, at his doctor’s recommendation, is taking a watchand- wait approach to his early stage prostate cancer.
When he arrives at the hospital, he is admitted for acute viral pneumonia and is given a COVID- 19 test, which comes back positive. Over the next few days he rapidly worsens, despite first getting oxygen, and then being put on a ventilator.
Five days after entering the hospital, he dies.
So what killed him? Was it COVID- 19? Or was it the pneumonia the COVID- 19 caused? If he did not have heart disease, he very well may have survived the pneumonia — so maybe it was that?
Multiple causes listed
Because it is so hard to tell, and defining the cause of death is so complicated, any responsible doctor will list all three of these on his death certificate, with COVID- 19 as the primary cause. It is cases like these that are at the heart of the recent controversy around a Centers for Disease Control and Prevention table that many have seized in an attempt to show that the true number of deaths from COVID- 19 is only 6% of what has been reported.
The argument stems from the fact that the vast majority of the more than 185,000 people who have died of COVID- 19 in the U. S. are like the man described above, and they have multiple causes listed on their death certificate.
Many people reason that since only 6% of people have COVID- 19 listed as the sole cause, the other 94% of deaths could be reasonably argued to have been from something else.
Flawed logic
This logic is flawed. If we really believed this, we would have to argue that our 70- year- old friend was destined to die when he did ( or soon after) even if he did not have COVID- 19.
In other words, we would be arguing the pneumonia or heart disease would have killed him, even if the COVID- 19 had not come along.
But that is almost certainly not the case. The pneumonia wouldn’t have, since it was a result of his COVID- 19 infection. The vast majority of comorbidities listed in the CDC’s table are like this, respiratory conditions likely caused by COVID- 19.
The heart disease potentially could have killed him, but he had lived with it for years, as many do. In the United States, 12% of the population has heart disease, 33% has hypertension and 15% has diabetes.
So while the COVID- 19 might not have killed him if these other things were not in the mix, it is almost certain that had he not caught the virus he would have survived longer.
The fact is that instead of making us overcount the number of COVID- 19 deaths, the difficulties figuring out the reasons people die are probably making us undercount them.
COVID- 19 tests are imperfect, and often give false negative results ( the test says someone is not infected, but they actually do have the virus).
When there is not a definitive COVID- 19 diagnosis, doctors are not likely to put the virus as a cause of death unless they have a very good reason to from clinical or epidemiologic information ( such as everyone else in the family tested positive).
Because COVID- 19 might not make it on to a lot of death certificates, a better way to count deaths is to look at how many more people have died each month than is typical.
Several organizations have been doing this, including the CDC and The Economist. These data suggest that we have seen more than 200,000 excess deaths so far this year, far more than show up in the COVID- 19 numbers.
Excess mortality
While the virus may not have directly caused all of these, it is impossible to reconcile this excess mortality with only 6% of reported COVID- 19 deaths being from the virus.
None of us will live forever, so death is always a matter of when, not if. That many people who have died of COVID- 19 may have been closer to death than the rest of us does not change the fact that the virus killed them before their time.
To argue that only 6% of these deaths are “real” not only discounts the impact of the COVID- 19 pandemic in the United States, it devalues the weeks, months or years all of those with underlying conditions still had to live if the virus had never come.