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The label “conspiracy theory’ is being tossed around. Especially if you question how COVID-19 deaths are counted. Obviously, such labels are to discourage anyone questioning official counts. I worked as a Registered Nurse in both acute care and Hospice settings. Therefore I understand how a complex clinical picture can contribute to the death of a patient.
There is a difference between COVID-19 being the immediate cause of death as opposed to a contributing cause. This is the difference between a healthy patient with no underlying conditions dying of COVID-19 and someone with one or more dying with the virus. It would be far more honest if the statistics were presented this way to the public. Especially since COVID-19 being the immediate cause of death are extremely low.
The Media’s Role
However with a corporate media invested in keeping the panic level as high as possible, this would not be prudent. This is evident from their full throated assault on the protocol involving hydroxychloroquine as a potential therapeutic. It is not damaging enough if a combination of inexpensive, approved drugs could limit the damage caused by the pandemic. Despite the fact there are ample pharmacological and biological reasons to believe it might.
Of course it was Jim ‘look at me’ Acosta who framed any questioning of the death count as a “conspiracy theory”. This gave Dr. Birx an opportunity to present a rationale for the counting. In listening to the explanation, I had no major disagreement with her position.
It also matched what I read about influenza death statistics. The estimated mortality from the flu is based on the number of laboratory confirmed patients who have influenza and die with the virus. In other words, the flu does not need to be the immediate cause of death. It just must be part of the clinical picture. So, in total counts it would seem the agency was being consistent. When a virus is part of a more complex medical picture it is counted as a cause of death.
The Directions
However, then I reviewed the memo from the National Center for Health Statistics on how to record deaths from COVID-19. From the memo (bold is from the original):
Should “COVID-19” be reported on the death certificate only with a confirmed test?
COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death. Certifiers should include as much detail as possible based on their knowledge of the case, medical records, laboratory testing, etc. If the decedent had other chronic conditions such as COPD or asthma that may have also contributed, these conditions can be reported in Part II. (See attached Guidance for Certifying COVID-19 Deaths)
The Problem
Wait a minute. Given how the deaths from influenza are handled, shouldn’t the answer to the question be a simple “yes”? According to the Coronavirus Task Force, every hospital lab in the country is able to do the COVID-19 test. Why in the world would a positive test not be required in this case?
Surely I must be misinterpreting the passage above, right? I would think so as well if the memo did not also contain this paragraph (emphasis mine):
What happens if the terms reported on the death certificate indicate uncertainty?
If the death certificate reports terms such as “probable COVID-19” or “likely COVID-19,” these terms would be assigned the new ICD code. It Is not likely that NCHS will follow up on these cases.
If “pending COVID-19 testing” is reported on the death certificate, this would be considered a pending record. In this scenario, NCHS would expect to receive an updated record, since the code will likely result in R99. In this case, NCHS will ask the states to follow up to verify if test results confirmed that the decedent had COVID- 19.
A Solution
This is even more disconcerting now that a clinical profile of COVID-19 has emerged. This is posted on the CDC website. The laboratory finding guidance goes so far as to provide the finding that are most common and those associated with severe illness. Even if you were to argue that a lack of testing would produce the need to assume a COVID-19 infection, the presence of predictable laboratory findings and a distinct progression of changes to imaging of the lungs, it seems the guidance on making COVID-19 a contributing factor to an individual’s death could be much more robust.
Using the ICD code should require proof of the elements of moderate to severe disease present in COVID-19. In the absence of such a clinical picture, the death should not list COVID-19 as a cause. There is an old saying about assuming that I won’t repeat here, but it appears there is very little need to assume a COVID-19 infection given what we know about how the disease affects the body in severe cases.
If it’s a “conspiracy theory” to point out the different criteria for monitoring COVID-19 as opposed the the flu, so be it. But the National Center for Health Statistics could easily tamp down questions by being explicit in the clinical data that is required to include it as an underlying cause of death. The time is quickly passing when it would be considered ethical not to require laboratory confirmation of the virus to include it. However, until then it is possible to be far more precise.
American Conservative Movement
Join fellow patriots as we form a grassroots movement to advance the cause of conservatism. The coronavirus crisis has prompted many, even some conservatives, to promote authoritarianism. It’s understandable to some extent now, but it must not be allowed to embed itself in American life. We currently have 8000+ patriots with us in a very short time. If you are interested, please join us to receive updates.
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