Hey everyone! I hope this post finds you and your family COVID free and enjoying the crisp and cool Texas summer. 

I had another thoughtful question from a friend of mine, thought I’d share my response for more people since I’m sure she isn’t the only one with this confusion. 

She stated:

“I have seen some say that cases of the regular flu have been included with the number of COVID cases. I have also heard that hospitals count all people who test positive as a COVID death regardless of the actual cause of death. I think these two instances could influence what the public is told. Perhaps you could shed some light on these”...?

Here was my reply

1. Bottom line is no, flu cases have not markedly overlapped or been somehow undercounted. Two quick reasons: flu season has been predictable for generations in that it ends in the U.S. in late March, or maybe early April. And second, we have some pretty good quality rapid flu tests available everywhere. So even when there was overlap (back 10 years ago in March and April when this started, ha) we tested everyone with those flu swabs and then negative cases were then sent for covid testing. 

2. The doubting of death certificate coding baffles me, as I have filled out well over a thousand death certificates in my career, but the people who doubt the COVID ones have never filled one out. (I mean, if you want to know something that makes you go hmmm....). Anyway. Here are the basic reasons why this is ludicrous. 

A. We have always used the final patient conditions to code for cause of death, as this is how epidemiology works. So if you have severe kidney disease but you contract a bacterial pneumonia and go into respiratory failure and die, the cause of death is bacterial pneumonia complicated by underlying kidney failure. Because the pneumonia is what accelerated the death. Likewise, a patient can live with heart disease for months or years, and then get a severe urinary tract infection that causes sepsis. Cause of death: sepsis from bacterial UTI complicated by heart disease. 

So if we stop coding COVID deaths when we observe COVID is what accelerated the deaths, we would also have to go back and revise all the infectious disease related deaths since the age of death certificates. 

B. The other reason it’s safe to assume a death is truly COVID related is that we have not known this virus for long, but it has kindly provided us with tens of thousands of autopsies in a short time frame. (Morbid sarcasm there, please accept my apologies). And in those autopsies, we have documented presence of viral particles in overwhelming amounts in the lung tissue, and also in the heart and cardiovascular tissue, in the GI tract, even in the brain and nervous system. We don’t see anything like that with influenza or most other respiratory viral deaths. So — even more than normal —it’s safe to say that COVID accelerated (aka caused) those deaths.

If you’ve followed me at all, you probably recall that I have posted something about these issues in the past, so this may not be new information. But I thought it might be timely to repost and restate, since there seems to be renewed interest in the test numbers as of late, and in Texas at least, our death numbers are spiking this last week. 

******Quick edit for those that want to post a video of someone saying any cause of death with a COVID positive is also counted :

The number of times that a death has been recorded as COVID related but was actually from a trauma are vanishingly small. If someone is at an accident scene and decided to insert a nasal swab into a victim, and they happened to come back three to five days later as positive, and those results were sent to the JP before she filled out the death certificate, then at that rarest of rare moments someone might have erroneously labeled a covid death that doesn’t belong. If you survive the accident and make it alive to the hospital, and they swab you there, as noted above, it still makes sense to believe that COVID and how it infiltrates the body in the way it does would make it exceedingly hard to recover from an injury. 

And second, in the example of the hospice patient, which the video announcer thinks helps prove his point, actually proves my point: as noted above, that is an appropriate COVID death, even on hospice patients, as it contributed and accelerated the death. Just like a cancer hospice patient who gets a UTI or pneumonia would be counted as well. 

As a public health official and someone who fills out death certificates, I’m begging you to trust me that I have considered those possibilities, that I know the less than a tiny percent chance of those things happening, that I realize the gravity of pronouncing decisions based on these deaths...and I stand behind the Texas DSHS, the CDC, and every epidemiologist everywhere when I tell you that we still need to pay attention to these numbers. *******(end edit)

Please remember that staying at home or away from others outside your family is the most effective means we have of lowering the spread. Our next best efforts need to be frequent hand washing, 6 feet apart when we do venture out, and wearing masks as often as possible. 

Y’all stay safe and keep cool!


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