Many years ago, one of my duties as a young surgical intern was to fill out death certificates for recently deceased patients. Under “cause of death,” Part I asked for the immediate cause, other conditions leading to it, and the underlying cause. Part II asked for “other significant conditions contributing to death but not resulting in the underlying cause given in Part I.” If you think this is confusing, you’re right. Did the post-operative patient found dead in bed really die of a heart attack, a pulmonary embolism, or some operative complication, like bleeding? Where do you list their colon cancer or hypertension?
The task has not gotten any easier during the Covid-19 pandemic. People are still dying of heart disease, stroke, cancer, and accidents. But now there is a new respiratory illness to account for. Not every decedent who tested positive for the virus that causes Covid-19 died from it—in fact, the disease is mild for most people. Conversely, some deaths due to Covid-19 may be erroneously assigned to other causes of death because the people were never tested, and Covid-19 was not diagnosed. Nearly everyone dying of Covid-19 has concurrent health problems—the average decedent has 2.5 co-morbid conditions—and hypertension, heart disease, respiratory diseases, and diabetes are among the most common. The presence and interaction of these co-morbid conditions is what sometimes changes Covid-19 from a relatively benign disease into a killer. But co-morbidities can also cause death regardless of Covid-19.
A common way to distinguish the mortality burden of a new infectious agent from other causes of death is to estimate the excess deaths that occurred beyond what would be expected if the pathogen had not circulated. A recent study of 48 states and the District of Columbia estimated 122,300 excess deaths during the pandemic period of March 1 to May 30, compared with expected deaths calculated from the previous five years. Deaths officially attributed to Covid-19 accounted for 78 percent of the total; approximately 27,000 deaths (22 percent) were not attributed to Covid-19. A second study, using the same database with different statistical methods for the period March 1 to April 25, found that 65 percent of 87,000 excess deaths were attributed to Covid-19.
Read the full article at City Journal.