6 Comments

1. > Santa Clara County: 25,705 cases, 424 deaths (25,543 cases, 421 deaths on Wednesday)

   Can anyone explain, with supporting references, what the government health authorities consider to be a “COVID-19” death?

   It has been reported variously that the health authorities report any death, from whatever cause, as a COVID-19 death if coronavirus is present. In some cases, a person who has been exposed to coronavirus but NOT testing positive is also considered to be a “COVID-19 case.

   Also, it has been reported that some health reporting lumps coronavirus together with seasonal flu, and calls any related death a “COVID-19 death”.

   As COVID-19 cases and deaths increase, seasonal flu cases and deaths decrease.

   If true, it sounds like the health authorities are overestimating COVID-19 cases and deaths by including seasonal flu cases.

   Hysteria over COVID-19 is severely disrupting people’s lives and fortunes. We need much more clarity in the health data on which the government’s anti-pandemic policies are based.

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2. sjoutsidethebubble,
   here is a link to the answers you seek. Pretty straight forward- for readers
   https://www.who.int/news-room/commentaries/detail/estimating-mortality-from-covid-19

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3. > “A COVID-19 death is defined for surveillance purposes as a death resulting from a clinically compatible illness in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID-19 disease (e.g. trauma).”

   As clear as mud.

   What is a “clinically compatible illness”?

   I’m guessing it’s an illness I can have at the same time I have COVID-19.

   So if I have leprosy and COVID-19 and I drop dead, it’s a COVID-19 death.

   And what is a “probable” COVID-19 case? It sounds like a case that HAS NOT been confirmed.

   If the hospital orderly looks at me and says “I think you probably have COVID-19”, that’s a COVID-19 case.

   It all sounds very, very sketchy with endless room for cooking the numbers.

   Not very “scientific” or “data driven”.

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4. @sjoutsidethebubble

   Why guess a definition when you can just use Google to answer your question? “Clinically compatible case: a clinical syndrome generally compatible with the disease, but no specific clinical criteria need to be met unless they are noted in the case classification.”

   So if someone dies of asphyxiation or organ failure, symptoms common to COVID-19, and the patient has tested positive for COVID-19, then they feel safe to call COVID-19 as a cause of death. Note that this doesn’t mean that it’s the only cause of death. As you said, a person may have multiple diseases, such a leprosy. If someone has tested positive for both those diseases, and the reason for death is organ failure, a doctor would feel safe to label both as the cause of death.

   You are right about how calling deaths not being very scientific, but is there a necessity for over specification? We are currently UNDERCOUNTING the deaths related to COVID. Compare the average amount of deaths in the past few decades and compare them to this year.

   I get the desire to get things back to normal, but demanding that community to ignore this pandemic is not the solution. People seem to like comparing this to the flu, but the flu kills 61k annually in USA on the higher estimation. Confirmed COVID deaths is already 236k and the year isn’t over yet (estimate is way past 300k according to average deaths). Right now, flu isn’t taking a break while COVID ramps up, so we as a community have to worry about both forever from now on if we don’t take this seriously. Let’s get through this together as a community, and hopefully we’ll finally be where South Korea is at in dealing with this disease.

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5. You will find that COVID-19 is the underlying cause of death–but usually the person dies from pneumonia, ARDS, hyper-coagulation, cellular thrombosis, etc, caused by the COVID-19.

   Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID–19)
   https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf

   Part I
   This section on the death certificate is for reporting the sequence of conditions that led directly to death. The immediate cause of death, which is the disease or condition that directly preceded death and is not necessarily the underlying cause of death (UCOD), should be reported on line a. The conditions that led to the immediate cause of death should be reported in a logical sequence in terms of time and etiology below it. The UCOD, which is “(a) the disease or injury which initiated the train of morbid events leading directly to death or (b) the circumstances of the accident or violence which produced the fatal injury” (7), should be reported on the lowest line used in Part I.

   Approximate interval: Onset to death
   For each condition reported in Part I, the time interval between the presumed onset of the condition, notthe diagnosis, and death should be reported. It is acceptable to approximate the intervals or use general terms, such as hours, days, weeks, or years.

   Part II
   Other significant conditions that contributed to the death, but are nota part of the sequence in Part I, should be reported in Part II. Not all conditions present at the time of death have to be reported—only those conditions that actually contributed to death.

   Vital Statistics Reporting GuidanceU.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics • National Vital Statistics System2Certifying deaths due to COVID–19

   If COVID–19 played a role in the death, this condition should be specified on the death certificate. In many cases, it is likely that it will be the UCOD, as it can lead to various life-threatening conditions, such as pneumonia and acute respiratory distress syndrome (ARDS). In these cases, COVID–19 should be reported on the lowest line used in Part I with the other conditions to which it gave rise listed on the lines above it.

   Generally, it is best to avoid abbreviations and acronyms, but COVID–19 is unambiguous, so it is acceptable to report on the death certificate. In some cases, survival from COVID–19 can be complicated by pre-existing chronic conditions, especially those that result in diminished lung capacity, such as chronic obstructive pulmonary disease (COPD) or asthma. These medical conditions do not cause COVID–19, but can increase the risk of contracting a respiratory infection and death, so these conditions should be reported in Part II and not in Part I.When determining whether COVID–19 played a role in the cause of death, follow the CDC clinical criteria for evaluating a person under investigation for COVID–19 and, where possible, conduct appropriate laboratory testing using guidance provided by CDC or local health authorities. More information on CDC recommendations for reporting, testing, and specimen collection, including postmortem testing, is available from: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html and https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-postmortem-specimens.html. It is important to remember that death certificate reporting may not meet mandatory reporting requirements for reportable diseases; contact the local health department regarding regulations specific to the jurisdiction.In cases where a definite diagnosis of COVID–19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID–19 on a death certificate as “probable” or “presumed.” In these instances, certifiers should use their best clinical judgement in determining if a COVID–19 infection was likely. However, please note that testing for COVID–19 should be conducted whenever possible.
   Common problemsCommon problems in cause-of-death certification include:
   1. reporting intermediate causes as the UCOD (i.e., on the lowest line used in Part I),
   2. lack of specificity, and
   3. illogical sequences.
   Intermediate causes are those conditions that typically have multiple possible underlying etiologies and thus, a UCOD must be specified on a line below in Part I. For example, pneumonia is an intermediate cause of death since it can be caused by a variety of infectious agents or by inhaling a liquid or chemical. Pneumonia is important to report in a cause-of-death statement but, generally, it is not the UCOD. The cause of pneumonia, such as COVID–19, needs to be stated on the lowest line used in Part I. Additionally, the reported UCOD should be specific enough to be useful for public health and research purposes. For example, a “viral infection” can be a UCOD, but it is not specific. A more specific UCOD in this instance could be “COVID–19.” All causal sequences reported in Part I should be logical in terms of time and pathology. For example, reporting “COVID–19” due to “chronic obstructive pulmonary disease” in Part I would be an illogical sequence as COPD cannot cause an infection, although it may increase susceptibility to or exacerbate an infection. In this instance, COVID–19 would be reported in Part I as the UCOD and the COPD in Part II. While there can be reasonable differences in medical opinion concerning a sequence that led to a particular death, the causes should always be provided in a logical sequence from the immediate cause on line a. back to the UCOD on the lowest line used in Part I.
   Manner of death
   The manner of death, sometimes referred to as circumstances of death, is also reported on death certificates. Natural deaths are due solely or almost entirely to disease or the aging process (8). In the case of death due to a COVID–19 infection, the manner of death will almost always be natural.

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6. People Die

   Get over it

   We should have never shut the country down in the first place

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