Infectious disease expert for VA, U of M slams 'idiotic' COVID-19 '6%' misinformation

The president shared a post falsely claiming the CDC said only 6% of the reported COVID-19 deaths in the U.S. were actually from the virus.
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An infectious disease expert from the University of Minnesota and Minneapolis VA has slammed an "idiotic" piece of COVID-19 misinformation that was removed from Twitter Sunday after being posted by an apparent QAnon follower, and shared by President Donald Trump.

The post by a Twitter account referring to themselves as "Mel Q" tweeted that the CDC had "quietly" updated its COVID-19 website to "admit that only 6% of all ... deaths actually died from COVID," adding: "That's 9,210 deaths." The tweet then goes on to note that the other 94% had "2-3 other serious illnesses" and that most were of advanced age.

The tweet, which was shared widely including being retweeted to the president's 85.6 million followers, was based on CDC table that shows the "types of health conditions and contributing causes mentioned in conjunction with deaths involving coronavirus disease 2019," and sparked widespread misinterpretation that insinuated that only 6% of COVID-19 deaths are actually from COVID.

The CDC page, which is regularly – rather than "quietly" – updated, notes that: "For 6% of the deaths, COVID-19 was the only cause mentioned."

Among the responses to the tweet was an article by right-wing website The Gateway Pundit – which was tweeted by the president's legal adviser, was subsequently retweeted the president, and has not been removed – that suggested the economy was shut down "based on 9,000 deaths."

As the CDC data specifies, COVID-19 was listed as the "only cause mentioned" on death certificates in 6% of cases, but it also notes that among the remaining 94%, along with underlying chronic illnesses such as diabetes and COPD, includes other "contributing causes of death" such as pneumonia, respiratory distress syndrome, respiratory failure, respiratory arrest, other diseases of the respiratory system, and sepsis.

These are acute conditions that often result from a COVID-19 infection, suggesting that there is a larger number of COVID-19 deaths without "underlying" health conditions.

As for those with underlying health conditions, their deaths would not have happened when they did without a COVID-19 infection, so the suggestion that lockdowns went into place because of "only" 9,210 deaths is misleading.

From the very start of the pandemic, the CDC and other public health experts have noted that those with one or more underlying health conditions such as chronic kidney disease, obesity, diabetes, heart conditions, COPD, sickle cell disease, and conditions that leave them in an immunocompromised state, are at a higher risk of dying from COVID-19.

The CDC estimates that as many as 60% of American adults have at least one of these conditions, with obesity the most common of these given that about 40% of American adults are considered clinically obese.

The speed at which the misinformation spread on social media prompted a number of rebuttals from experts, among them University of Minnesota Associate Professor Dimitri Drekonja who is the chief of the Minneapolis VA Healthcare System's infectious disease section.

In a Facebook post Monday, he said he felt "the unfortunate need to debunk this stupid idea going around that 94% of COVID deaths were not due to COVID, or that the COVID deaths are somehow being inflated."

"It's idiotic and wrong, and unfortunately being used as just one more form of misinformation," he said.

He notes that COVID-19 death figures are compiled using death certificates filled out by doctors, physicians assistants and registered nurses. He concedes it's not the "perfect data source" as it relies on doctors filling it out "and some people are not good at following instructions," but it's "pretty much the best we have."

The CDC data provides "comprehensive description" of COVID-19 deaths, noting it's a "terrible disease for the elderly, also terrible for those with co-morbities (obesity alone counts)," as well as "some unlucky people who are young and healthy."

He then goes on to explain how death certificates are filled out and handle underlying conditions that contribute to people's deaths.

"If you look at the attached picture (see at bottom of this page), in part one the person completing the form enters the immediate cause of death in Ia. For an 80 y/o man with heart disease and diabetes who came in with a positive COVID test and died on the ventilator, I would enter 'COVID-19.' It then asks if any conditions lead to the immediate cause – in this case, would enter none. Finally, in part II it asks 'Other significant conditions contributing to death' – that's where I would list coronary artery disease and diabetes. And that is where the data on comorbidities comes from.

"No conspiracy. Nothing done differently than if someone had died of influenza. They all died of COVID. So please, don't feed this nonsense."

Other hypothetical examples

Even in instances where COVID-19 is the "only cause" in a death, other conditions should still be listed on a death certificate that has been filled out correctly.

As palliative care physician Dr. Bartlett Pear noted in a post on Sunday, that's because COVID-19 triggers a severe reaction that can result in a person's death, such as respiratory failure, pneumonia, cardiac arrest, and septic shock, among others.

Pear, who says she has filled out hundreds of death certificates during her career, cites an example of a hypothetical 62-year-old patient called John who has hypertension and is obese, who contracts COVID-19 and dies from "Hypoxemic Respiratory Failure" after going into "Acute Respiratory Distress Syndrome." Such a death certificate may contain three primary causes of death (HRF, ARDS, and COVID-19) and two underlying conditions.

"What should we choose as the immediate cause of death?

I would go with”Hypoxemic Respiratory Failure.”

Okay, moving on to line 2. What lead to John’s Hypoxemic Respiratory Failure?

It seems that ARDS was the condition directly leading to the Hypoxemic Respiratory Failure. So I would type “Acute Respiratory Distress Syndrome” into line 2 (the freaking death registry doesn’t like it when we use acronyms…grr).

Now line 3…what lead to John’s ARDS?

This is where we would list Sars-CoV-19.

...

Now on to the box for other conditions that may have contributed to death, but weren’t directly related to the underlying cause, which in John’s case was Sars-CoV-19.

It would probably be reasonable to list “Hypertension” and “elevated BMI” as conditions that may have contributed to death as we know that hypertension and obesity are risk factors for death in Covid-19."

She then provide an example of a COVID-19 death in someone who dies without any underlying conditions, a 35-year-old server who contracts COVID-19 at work and develops pneumonia, while a CT scan shows a small pulmonary embolism.

"Immediate cause of death: We could go with “Hypoxemic Respiratory Failure” again for Jennifer.

What lead to this? I would list “Multifocal Pneumonia” though you could make a case for the pulmonary embolism as well.

And what caused the Multifocal Pneumonia? This is where we list Sars-CoV-19.

Other contributing conditions? Jennifer doesn’t really have any – we can leave that box empty.

So even in this otherwise healthy 35 year old woman, her death certificate will list Sars-CoV-19 as well as two other diagnoses."

COVID-19 in Minnesota

In Minnesota, the state's COVID-19 death count is compiled based upon the death certificates filled out by doctors, physicians assistants and RNs.

In the event that a doctor suspects COVID-19 was the cause of death but the patient didn't get tested in time, it can be listed as "probable COVID-19" on the death certificate.

These deaths are not included in the total Minnesota tally, and instead are dealt with separately in the Minnesota Department of Health official figures. There have been 49 "probable" COVID-19 deaths so far.

In response to Drekonja's response, St. Paul pathologist Emily Duncanson commented that as well as being reviewed by MDH, many of Minnesota's COVID-19 death reports are also reviewed by medical examiner offices.

"In many counties, COVID has been made reportable to the ME, so the ME offices are reviewing the medical record of every death that is suspected or possible COVID and they’re signing the DC (death certificate)," she wrote. "This means hundreds of death certificates and painstaking reviews every day at certain points in the pandemic.

"This is what forensic pathologists are trained to do, unlike any other MDs who receive little or no training on death certification. Since the beginning of this pandemic I’ve been so frustrated by the attacks on my specialty and the erasure of the hard work my colleagues are doing to ensure the accuracy of death records and public health stats.

"Also DC information as far as I know is not a determinant in hospital billing so no we are not conspiring to get more money for hospitals."

The last comment comes after some, including Minnesota family doctor and lawmaker Scott Jensen, have suggested that medical practices are being encouraged to incorrectly attribute deaths to COVID-19 due to higher reimbursement levels from the Medicare program.

Rather than overcounting, there's a possibility that COVID-19 deaths are being undercounted in the U.S, given that the number of "excess deaths" being reported in the country this year is higher than the number of confirmed deaths from the virus.

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