Case Fatality Rate, Centers for Disease Control, Co-Morbidities, Coronavirus, Covid "Hot Spots", Covid-119, Crisis Management, Data Integrity, Death Toll, Excess Deaths, Government Accounting, Influenza, New York Deaths, Probable Deaths, Respiratory Disease, Testing Guidelines
The Centers for Disease Control has formally decided to inflate statistics on coronavirus deaths by adding so-called “probable” cases to the toll. This news follows the announcement yesterday that New York decided to add, in one day, about 4,000 deaths from over the past month to its now “probable” Covid-19 death toll. So much for clean accounting! We have a confirmed death toll up to April 14th. We have a probable death toll after. The error in timing alone introduced by this abrupt adjustment impairs efforts to track patterns of change. Case fatality rates are rendered meaningless. Data integrity, which was already weak, has been thrown out the window by our public heath authorities.
It’s no longer necessary for a deceased patient to have tested positive for Covid-19:
“A probable case or death is defined as one that meets clinical criteria such as symptoms and evidence of the disease with no lab test confirming Covid-19. It can also be classified as a probable case if there are death or other vital records listing coronavirus as a cause. A third way to classify it is through presumptive laboratory evidence and either clinical criteria or evidence of the disease.”
Consider the following:
- to date, more than 80% of patients presenting symptoms sufficient to meet testing guidelines have tested negative for Covid-19;
- the most severe cases of Covid-19 and other respiratory diseases are coincident with significant co-morbidities;
- “probable” cases appear to be concentrated among the elderly and infirm, whose regular mortality rate is high.
Deaths involving mere symptoms, or mere symptoms and co-morbidities, and even deaths of undetermined cause, are now more likely to be over-counted as Covid-19 deaths. This is certain to distort, and I believe overcount, Covid-19 deaths. Of course, this was already happening in some states, as I mentioned last week in “Coronavirus Controversies“.
One of the charts I’ve presented in my Continue%20reading Coronavirus “Framing” posts tracks Covid-19 deaths. The change in these cause-of-death guidelines will make continued tracking into something of a farce. I’d be tempted to deduct the one-day distortion caused by the New York decision, but then the count will still be distorted going forward by the broader definition of Covid-19 death.
The only possible rationale for these decisions by New York and the CDC is that testing is still subject to severe rationing. I have my doubts, as the number of daily tests has stabilized. On the other hand, I have heard anecdotes about hospitals with large numbers of respiratory patients who have not been tested! And they are intermingling all of these patients?? I’m not sure I can reconcile these reports. Surely the patients meet the guidelines for testing. Perhaps the CDC’s decision is associated with an effort to spread testing capacity by allowing only new patients to be tested, counting those already hospitalized as presumptively Covid-infected. And if they aren’t already, they will be! A decision to count deaths within that group as “probable” Covid deaths would fit conveniently into that approach, but that would be wildly misguided and perverse.
I’m obviously cynical about the motives here. I don’t trust government accounting when it bears on the credit or blame for crisis management. Who stands to gain from a higher Covid death toll? The CDC? State health authorities? “Hot spots” vying for federal resources?
A consistent approach to attributing cause of death would have been more useful for gauging the direction of the pandemic, but as I’ve said, there will always be uncertainty about the true Covid-19 death toll. Ultimately, the best estimates will have to rely on calculations of “excess deaths” in 2020 compared to a “normal” level from a larger set of causes. In fact, even that comparison will be suspect because the flu season leading up to the Covid outbreak was harsh. Was it really the flu later in the season?