By Larry Quick
Fifth in a series.
The previous articles is at thevoice.us/questions-arise-on-state-covid-19-statistical-accuracy
This week we will consider COVID-19 death statistics published by the Illinois Department of Public Health (IDPH) and the Kane County Health Department.
Certified public accountants recognize the necessity for correct account classification of financial transactions. Correct account coding permits accurate financial statements. Incorrect account coding produces inaccurate financial statements. Similarly, accurate cause of death coding permits accurate death reports. Inaccurate cause of death coding produces inaccurate death reports. Are death coding practices used by physicians and coroners in Illinois and Kane County, generating accurate COVID-19 death statistics?
April 3, the CDC’s National Center for Health Statistics issued guidance to physicians, coroners, and medical examiners, who fill out death certificates to list COVID-19 as an underlying cause of death in the absence of a test. The guidelines specify:
“In cases where a definite diagnosis of COVID-19 cannot be made, but it is suspected, or likely, it is acceptable to report COVID-19 on a death certificate as probable, or presumed. In these instances, certifiers should use their best clinical judgment in determining if a COVID-19 infection was likely. However, please note that testing for COVID-19 should be conducted whenever possible.”
These COVID-19 death reporting guidelines do not require autopsies, a positive CT scan, or a positive lab test. Only physician presumption, or assumption, of COVID-19 morbidity, is required for COVID-19 to be listed on a death certificate.
Dr. Daniel Erickson, an MD practicing in Bakersfield, Calif., reports that physicians in many states are being pressured in-house, to add COVID-19 to their death reports, as a cause of death. Dr. Erickson states that hospitals receive more insurance reimbursement if a patient’s death is coded with COVID-19. For non-COVID-induced pneumonia hospitals receive approximately $5,000 in Medicare reimbursement. For COVID-induced pneumonia hospitals receive approximately $13,000 in Medicare reimbursement.
Epidemiologists make a clear distinction between death from a virus, and death with a virus. Death from a virus indicates that the virus actually caused an individual’s death. Death with a virus indicates that the actual cause of death was not the virus, but another medical cause, such as heart, kidney or lung disease. SARS-CoV-2 is a respiratory virus. In death with a virus, a deceased individual tests positive for SARS-viral DNA, but the SARS-Cov-2 virus was not the actual or immediate cause of death.
In April 2020, a high-level Illinois health official, Dr. Ngozi Ezike, explained, that any victim diagnosed with the novel coronavirus, would be classified as a COVID-19 death, regardless of whether it contributed to the patient’s death. “If you died of a clear alternate cause, but you had COVID-19 at the same time, it’s still listed as a COVID-19 death,” Dr. Ngozi Ezike, director of IDPH, explained to reporters. Her statement can be viewed at: www.youtube.com/watch?v=H5FdnrRR2iY
As of September 3, IDPH reported 8,091 Illinois COVID-19 deaths. Based on Dr. Ezike’s comments, this number necessarily includes many deaths classified as deaths with, but not from, COVID-19. IDPH does not separately report the actual number of deaths from COVID-19. As of September 3, IDPH reported 314 COVID-19 deaths in Kane County.
The above factors are most likely resulting in the significant overstatement of actual COVID-19 deaths in Illinois. For perspective, the U.S. the average daily death count from all causes is close to 8,000 deaths. The Illinois average daily death count from all causes averages close to 300 deaths.
The CDC (Centers for Disease Control and Prevention) has compiled a table of COVID-19 death statistics and published the following statement:
“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. The number of deaths with each condition or cause is shown for all deaths and by age groups.” bit.ly/2ZeoMC4
This data suggests the possibility that up to 94% of reported COVID-19 deaths could have an actual or immediate cause of death, other than the SARS-Cov-2 virus.
COVID-19 deaths reported by state and county authorities should only include medically and scientifically confirmed deaths, where the actual cause of death was COVID-19. Scientific confirmation is achieved with autopsies, CT scans, accurate lab tests and physician examinations. Without accurate medical and scientific confirmation, actual deaths from COVID-19 may be significantly overstated. A material overstatement of COVID-19 deaths, can lead to misguided and damaging public policies, and unwarranted fear on the part of Illinois and Kane County residents. State and county authorities must take steps to assure that the actual number of deaths from COVID-19 are accurate and not over reported. Next week we will assess the risk that COVID-19 poses to Kane County residents.
Continued at thevoice.us/all-respiratory-viruses-follow-a-bell-shaped-pattern