Thursday, December 3, 2020

How the CDC increased the number of reported Covid deaths and decreased the numbers of all other causes of deaths

1.  The CDC issued new guidance that required doctors who complete death certificates to list Covid-19 on the certificate if it contributed to or caused the death.  This was no different than what we did before.  We are supposed to list all contributory causes.

"It is important to emphasize that Coronavirus Disease 2019 or 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." 

2.  Without fanfare, CDC acknowledged on another webpage (below) that even if Covid was NOT listed by the doctor as the underlying cause of death, or the proximate cause of death, as long as it was listed as one of the causes or contributors, it would be coded as the cause of death of Death and COVID-19

"Cause of Death and COVID-19

When COVID-19 is reported as a cause of death on the death certificate, it is coded and counted as a death due to COVID-19." 

This almost unnoticeable sleight-of-hand by CDC was performed like a magician's trick.  CDC misdirected us to focus on how death certificates were to be completed (which did not change) while CDC quietly changed the way it would attribute the cause of death. It seems that as long as Covid was listed anywhere among the diagnoses in Part I or Part II of the death certificate, CDC would call it a Covid death. Pretty clever.

This could well be the explanation for why Dr. Briand at JHU found that reported deaths from all other causes are considerably down this year, in an amount that approximates the number of reported deaths from Covid

Here the major causes of death and their numbers are graphed from 2014-2020.


Graph depicts the number of deaths per cause during that period in 2020 to 2018.

This trend is completely contrary to the pattern observed in all previous years. Interestingly, as depicted in the table below, the total decrease in deaths by other causes almost exactly equals the increase in deaths by COVID-19. 

In May, the Governor of Colorado announced that the state was reducing the number of Covid-caused deaths by 23%, acknowledging that every death "with" Covid had been getting counted as a death "due to" Covid. One wonders what CDC assigned as the cause of death for those 23% of deaths that were determined to not be due to Covid, at the state level. One wonders if CDC misassignment of deaths had anything to do with Trump's demand that hospitals stop sending their data to CDC and sending it directly to a White House contractor.


John F. McGowan, Ph.D. said...

This appears to be what is done on the CDC's FluView web site which attributes 6-10 percent of deaths to pneumonia and influenza, about 188,000 deaths per year prior to 2020. Compared to about 2 percent in the Leading Causes of Death report, about 55,000 deaths per year. These numbers differ by a factor of over THREE.

FluView: (click on P&I Mortality tab)

US Influenza Surveillance System: Purpose and Methods

See section five (5) titled Mortality Surveillance. Note the language "a cause of death" in the second paragraph copied below (emphasis using *** added):

5. Mortality Surveillance

National Center for Health Statistics (NCHS) mortality surveillance data – NCHS collects death certificate data from state vital statistics offices for all deaths occurring in the United States and are aggregated by the week of death occurrence. Deaths are classified based on ICD-10 multiple cause of death codes as associated with influenza, COVID-19, or pneumonia. To allow for collection of enough data to produce a stable percentage, NCHS surveillance data are released one week after the week of death and percentages for earlier weeks are continually revised and may increase or decrease as new and updated death certificate data are received by NCHS.

In previous seasons, the NCHS surveillance data were used to calculate the percent of all deaths occurring each week that had pneumonia and/or influenza (P&I) listed as ***a cause of death***. Because of the ongoing COVID-19 pandemic, COVID-19 coded deaths were added to P&I to create the PIC (pneumonia, influenza, and/or COVID-19) classification. PIC includes all deaths with pneumonia, influenza, and/or COVID-19 listed on the death certificate. Because many influenza deaths and many COVID-19 deaths have pneumonia included on the death certificate, P&I no longer measures the impact of influenza in the same way that is has in the past. This is because the proportion of pneumonia deaths associated with influenza is now influenced by COVID-19-related pneumonia. The PIC percentage and the number of influenza and number of COVID-19 deaths will be presented in order to help better understand the impact of these viruses on mortality and the relative contribution of each virus to PIC mortality.

More details here: How Reliable are the US CDC's Death Numbers:

It is not a new trick; they have been doing it for years.

Meryl Nass, M.D. said...

Hi John.

This is a different trick. CDC has used estimates instead of real counts (max number of death certificate-defined flu deaths in past 10 years is 6515/yr, while estimates have ranged from about 24-80K)

CDC has used lumping of diagnoses to obscure the low rates of flu deaths.

But to my knowledge CDC has never before dared to change the cause of deaths listed on death certificates in a wholesale manner, and for only one diagnosis, Covid.

They made the vital statistics data hard to find, but I never before saw CDC alter the cause of death when there is no evidence to do it. It's kind of like bringing in a suitcase of ballots at 3 am. Hey, it's 2020. Anything goes!

John F. McGowan, Ph.D. said...

Hello Meryl,

You have probably seen this, but just in case. Briefly they argue that these changes in how COVID is reported violate various data integrity laws and likely inflate the death totals. Claim is they did not go through a required public comment process etc.

Ealy, H, M McEvoy, D Chong, J Nowicki, M Sava, S Gupta, D White, J Jordan, D Simon and P Anderson. COVID-19 Data Collection, Comorbidity & Federal Law: A Historical Retrospective. Science, Public Health Policy & the Law Oct 2020 2:4-22. (Reviewing Editor: James Lyons-Weiler) Corresponding Author Dr. Ealy,

According to the Centers for Disease Control and Prevention (CDC) on August 23, 2020, “For 6% of the deaths, COVID-19 was the only cause mentioned. For deaths with conditions or causes in addition to COVID-19 , on average, there were 2.6 additional conditions or causes per death.”[1] For a nation tormented by restrictive public health policies mandated for healthy individuals and small businesses, this is the most important statistical revelation of this crisis. This revelation significantly impacts the published fatalities count due to COVID-19. More importantly, it exposes major problems with the process by which the CDC was able to generate inaccurate data during a crisis. The CDC has advocated for social isolation, social distancing, and personal protective equipment use as primary mitigation strategies in response to the COVID-19 crisis, while simultaneously refusing to acknowledge the promise of inexpensive pharmaceutical and natural treatments. These mitigation strategies were promoted largely in response to projection model fatality forecasts that have proven to be substantially inaccurate. Further investigation into the legality of the methods used to create these strategies raised additional concerns and questions. Why would the CDC decide against using a system of data collection and reporting they authored, and which has been in use nationwide for 17 years without incident, in favor of an untested & unproven system exclusively for COVID-19 without discussion and peer-review? Did the CDC’s decision to abandon a known and proven effective system also breach several federal laws that ensure data accuracy and integrity? Did the CDC knowingly alter rules for reporting cause of death in the presence of comorbidity exclusively for COVID-19? If so, why?