COVID-19: “Generous” Death Certification

(Part 5 in a series of indeterminate length, dissecting the pandemic narrative)

In previous posts, I’ve concluded that the infamous SARS-CoV-2 virus is of questionable provenance, and that the RT-PCR test used for diagnosing COVID-19 is a bit sketchy. Those issues aside, what about attribution of COVID-19 as cause of death? Now, generally, medical examiners and coroners know how to fill out death certificates, as do most physicians and pathologists. I think I’m on firm ground here.

For some reason, however, in the case of COVID-19, medical professionals have been inundated with guidance on how to certify deaths. And lo and behold, this guidance seems to constitute a radical departure from tradition, in a way that tends to inflate case and death numbers for COVID-19. Let me pause here to lift my jaw off the floor… okay, I’m good now. Per a generally excellent investigation¹ published on the Children’s Health Defense website, the CDC went out of its way in a March 24, National Vital Statistics System (NVSS) “Alert” to override long-accepted norms and ensure that COVID-19 fatalities would be grossly inflated. The memo explicitly stated, “the rules for coding and selection of the underlying cause of death are expected to result in COVID19 being the underlying cause more often than not.” Thus, a death “with” COVID-19 will almost always become a death “due to” COVID-19 (which is NOT the case with influenza, according to many medical authorities). Subtlety apparently isn’t the CDC’s strong suit. Further, the CDC suggested that all comorbidities (other conditions that had afflicted the deceased) contributing to a fatality be listed in Part II of Item 32 of the Standard Certificate of Death. In the past, only those unrelated or minor comorbidities not considered underlying causes of death were listed in Part II.

Perhaps COVID-19 fatalities were still disappointingly low, because the CDC further liberalized death reporting – via a loosening of what constitutes a COVID-19 “surveillance” case – in a position paper approved on April 5th. As far as I can tell, surveillance data^2,3 is what the CDC uses in producing its statistics on the outcomes and demographics of infectious diseases. As the accompanying press release put it:

NOTE: A surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance. Surveillance case definitions enable public health officials to classify and count cases consistently across reporting jurisdictions. Surveillance case definitions are not intended to be used by healthcare providers for making a clinical diagnosis or determining how to meet an individual patient’s health needs.Centers for Disease Control and Prevention.

“Coronavirus Disease 2019 (COVID-19) 2020 Interim Case Definition” 5 Apr 2020, https://wwwn.cdc.gov/nndss/conditions/coronavirus-disease-2019-covid-19/case-definition/2020/.

Particularly striking are the very general symptoms (cough, shortness-of-breath, difficulty breathing) that could result in a COVID-19 diagnosis (and thus, if the patient dies, a likely appearance of COVID-19 as an underlying cause). Further, the paper indicated that a fatality could be classified as COVID-19 based on a single positive RT-PCR (amplification) test – a dodgy practice given the test’s demonstrated propensity to produce false positives – or simply the inclusion of COVID-19 as an underlying cause (not necessarily the primary underlying cause) on a death certificate. The significance of this will be seen later. Moreover, the Children’s Health Defense piece notes that the new standard opened the door for medically unqualified “contact tracers” to play a major role in diagnosis through their influence on epidemiological evidence. This guidance certainly opened many avenues for squeezing fatalities into a “probable” COVID-19 category. I find the CDC disclaimer helpfully revealing, that surveillance case guidance should not affect the judgement of healthcare providers in making a clinical diagnosis. Presumably, we could have many instances wherein the presiding physician(s) chose NOT to diagnose COVID-19, yet the official CDC statistics would – if the patient died – count it as a coronavirus death.

An aspect of this issue that has gone unreported, to my knowledge, is that in making all these changes to how deaths are tallied, the CDC has failed to meet their obligations for formal approval via the Federal Register process. Per a study in published in a journal called Science, Public Health Policy, and the Law:

Supportive data comparisons suggest the existing COVID-19 fatality data, which has been so influential upon public policy, may be substantially compromised regarding accuracy and integrity, and illegal under existing federal laws. If the fatality data being presented by the CDC is illegally inflated, then all public health policies based upon them would be immediately null and void. [emphasis mine]

Ealy, H, et al. “COVID-19 Data Collection, Comorbidity & Federal Law: A Historical Retrospective.” Science, Public Health Policy & the Law Oct 2020 2:4-22. (Reviewing Editor: James Lyons-Weiler), https://cf5e727d-d02d-4d71-89ff-9fe2d3ad957f.filesusr.com/ugd/adf864_165a103206974fdbb14ada6bf8af1541.pdf

In case readers are wondering, this “generous” COVID-19 accounting is being done in other countries besides the U.S.; for example, the UK, as Dr. John Lee describes:

But there’s another, potentially even more serious problem: the way that deaths are recorded. If someone dies of a respiratory infection in the UK, the specific cause of the infection is not usually recorded, unless the illness is a rare ‘notifiable disease’.

So the vast majority of respiratory deaths in the UK are recorded as bronchopneumonia, pneumonia, old age or a similar designation. We don’t really test for flu, or other seasonal infections. If the patient has, say, cancer, motor neuron disease or another serious disease, this will be recorded as the cause of death, even if the final illness was a respiratory infection. This means UK certifications normally under-record deaths due to respiratory infections.

Now look at what has happened since the emergence of Covid-19. The list of notifiable diseases has been updated. This list — as well as containing smallpox (which has been extinct for many years) and conditions such as anthrax, brucellosis, plague and rabies (which most UK doctors will never see in their entire careers) — has now been amended to include Covid-19. But not flu. That means every positive test for Covid-19 must be notified, in a way that it just would not be for flu or most other infections.

Lee, Dr. John. “How deadly is the coronavirus? It’s still far from clear” 28 Mar 2020, https://www.spectator.co.uk/article/The-evidence-on-Covid-19-is-not-as-clear-as-we-think.

It fact, health authorities around the world, almost without exception, have admitted that they report every death “with” COVID-19 as a death “due to” COVID-19. This implies that if COVID-19 appears anywhere on the death certificate, whether as the primary underlying cause or not, the NCHS and CDC will report the death in the COVID-19 bucket. This starkly contrasts with normal practice for infectious diseases.

Certainly, when authorities tell us that this malady is far more deadly than influenza, we should be somewhat skeptical – COVID-19’s criteria are vastly more liberal than the customary criteria that would be used to attribute a death to the flu. Actually, flu death accounting in the U.S. is a mess, given that the CDC reports flu deaths in one big bucket, combined with pneumonia deaths. Allegedly, the impetus for lumping flu deaths into this much larger (absent a killer flu pandemic) category appears to be that demand for flu vaccines was quite weak; thankfully (for drug companies, anyway) a carefully worded fear campaign, combined with a misleading high fatality statistic, managed to goose up flu vaccination rates. Moreover, in many cases, it’s simply not known whether the deceased had the flu; and if they did, whether it played a significant role in the death of the patient. So public health officials are left to guess at annual influenza deaths. The number that’s generally tossed around as the annual average is 36,000. According to Dr Kenneth Stoller, a pediatrician, before 2003, when the 36,000 figure became the standard, the CDC estimated that only 20,000 Americans died of the flu annually, and the toll was declining. Stoller also reports that, “Between 1979 and 2002, NCHS data show an average 1348 flu deaths per year (range 257 to 3006).” That’s a far cry from 36,000 or even 20,000. If these figures are close to the mark (and some authorities think even these are vast overestimates; the Huffington Post article notes that only 18 of the 257 flu deaths in 2001 were confirmed as true flu cases), then it’s no big deal if COVID-19 is bigger killer than typical influenza.

For additional perspective on how COVID-19 death figures are produced, see this NBC News report.

[To date in my investigation of the pandemic, I’ve found that authorities can’t confirm the existence, let alone the lethality, of SARS-CoV-2, which puts everything else in the official narrative on thin ice, to say the least. Moreover, even taking the word of the “experts” as to the reality of SARS-CoV-2 as a killer virus, there are huge problems with the RT-PCR test, and plenty of reasons to doubt the official case and death statistics. In my next post, I’ll look into the matter of “excess mortality,” that is, are more people dying than usual in the U.S. and other “infected” countries? Significant excess mortality must be present in order to even begin to justify the draconian measures that have been imposed nearly worldwide, and indeed, for COVID-19 to merit the term “pandemic.”]

¹ The Children’s Health Defense article is well done, but it creates confusion by stating:

It’s worth noting that Part I of a death certificate is the immediate cause of death listed in sequential order from the official cause on line item (a) to the underlying causes that contributed to death in descending order of importance on line item (d), while Part II is/are the significant conditions NOT relating to the underlying cause(s) in Part I.

Ealy, McEvoy et al. “If COVID Fatalities Were 90.2% Lower, How Would You Feel About Schools Reopening?” 24 July 2020, https://childrenshealthdefense.org/news/if-covid-fatalities-were-90-2-lower-how-would-you-feel-about-schools-reopening/.

Really, as we move down the page from the official cause to the final underlying cause, the causes are in ascending, not descending order of importance. I think that, since the movement is down the page, the authors used the word descending, but really, the term is inapt because it is referring to importance (magnitude), not spatial direction. To be clear, what is most often (but certainly not always) cited as the underlying (primary) cause of death is the lowest line on Item 32 of Part I of the Standard Certificate of Death.

² When I asked the CDC whether the scary, “official” COVID-19 fatality numbers we are constantly bombarded with are from the surveillance data, they failed to actually answer the question (their email offered, “All the data that Surveillance receives and uses in the Covid Data Tracker are obtained from each state health department.” Gee, thanks). However, perusing the CDC website, it becomes clear that all of the tables that included COVID-19 mortality data, save a number of ad-hoc tables, are listed under the “NVSS COVID-19 Surveillance Data Files” heading.

³ An expert at the CDC provided some corroboration of how cause of death is normally assigned, as well as how the rules have been relaxed in order to properly track the COVID-19 pandemic”

Just about all tables that we publish in our usual reports and publications are based on the “underlying cause of death.” The WHO defines the “underlying cause of death” as:

“the disease or injury that initiated the train of morbid events leading directly to death or the circumstances of the accident or violence that produced the injury.”

https://stats.oecd.org/glossary/detail.asp?ID=2790

The tables used for surveillance of mortality involving COVID-19 are an exception to this general way of tabulating data. This is a necessity of the surveillance purpose of these tables.

Selecting the underlying cause among the many that might be listed on a death certificate is not necessarily easy nor straightforward. You are correct in suggesting that it is usually the condition entered in the lowest-used line of Part 1 on the death certificate.

All WHO member countries follow a set of rules to select the underlying cause. Our version of these rules can be found distributed in the various instruction manuals found here:

https://www.cdc.gov/nchs/nvss/instruction_manuals.htm

Minino, Arialdi M. (CDC/DDPHSS/NCHS/DVS). “RE: DVS (Mortality- Certificate of Death)_RESPONSE REQUIRED; Priority Medium; Mode WebForm; Topic Mortality Statistics; [CDC-861245-N4S0K6] CRM:00703210.” Message to author. 10 August 2020. E-mail.