In 2020 there were 385,293 deaths that mentioned Covid-19 on the certificate. Of those, 351,530 listed Covid-19 as the underlying cause of death. (In other words, 33,763 deaths, about 9%, listed Covid-19 as incidental but not necessarily the ultimate cause.) I wanted to take a closer look, because this seemed lopsided to me. Quick overview, the CDC's mortality data list an ultimate cause of death, the single thing that is fingered as the reason the person died. It also lists up to 20 (though typically only three to five) contributing causes of death, things that are relevant but not deemed the ultimate cause. So if someone has a chronic lung condition and dies after contracting covid, most likely the chronic condition will be listed as a contributing cause with "Covid-19" listed as the ultimate cause.
If you've followed my blog for a while, you've seen my analyses of the CDC's statistics on drug-related mortality. One pattern I've noticed is that if a drug is mentioned, it's overwhelmingly (>90% of the time) listed as the ultimate cause of death. At the same time, you see a lot of chronic illnesses getting listed on these records as contributing causes of death. Is there some bias whereby if drugs are anywhere in the picture they get fingered as the ultimate cause? Or are medical examiners assiduously avoiding any mention of drugs if they don't think they're relevant to the causal story? (While at the same time promiscuously reciting details about the decedents medical history in drug cases?)
I had a similar thought about the 2020 covid deaths, so I took a closer look. What does a "covid caused" death look like compared to a "covid mention" death (in which presumably covid was incidental)? Early in the pandemic, I suspected that there was some kind of misclassification happening, where covid was blamed even if it was incidental. Such a bias in reporting would inflate the death toll. The excess death statistics quickly ruled that out as a plausible explanation, because those are a measure of total overall mortality and it's implausible that those numbers could be inaccurate. But it could still be true that there is a significant amount of misclassification happening. Excess deaths don't exactly overlap with covid deaths, so there's room for error here.
After looking into the data, my takeaway is that the deaths really do look like covid deaths. I don't have the actual death certificates, but I do have the large mortality file from 2020 (the Multiple Mortality Cause Files in this link). With this I can see which conditions are listed on a given record. I see a lot of conditions such as: pneumonia, chronic obstructive pulmonary disease, hypertensive heart disease without congestive heart failure, adult respiratory distress syndrome, cardiac arrest, respiratory failure unspecified, etc. A typical record will list multiple conditions. The average age of decedent is 76. Taken together, this corroborates the story that this disease mostly struck down the sick and the elderly.
I actually didn't see a huge difference between the records that were marked as covid being the underlying cause versus the ones where some other cause was marked as primary. They are listing the same set of conditions, and the age distributions are similar. If you look at the underlying cause of death for the "covid mentions" records, you see a lot of chronic conditions. Malignant neoplasms (cancer) of the prostate, Parkinson's disease, Alcoholic hepatitis, Other Obesity, Heart failure, Unspecified dementia, etc. You see a lot of these listed as contributing causes of death on the records for which covid was selected as the ultimate cause. I don't know exactly by what rubric a death is ruled to be "caused" by covid rather than having it listed as a contributing condition. Presumably someone is making that ruling, but these things can be a little arcane.
I think there's more work to do here, particularly when the 2021 file comes out (which should happen near the end of 2022). There should be a more thorough analysis comparing the official counts of covid deaths to the excess mortality numbers to see if they match up or not. If they don't match fairly closely, it could imply that there is excess mortality (or less than expected mortality) due to some of the lockdown measures. Presumably the disruption of medical services had an effect on some people getting necessary healthcare, and it seems that suicides and "deaths of despair" increased during the past two and a half years. Excess deaths for younger demographics far exceed the official covid counts. It's not plausible that we're under-reporting covid deaths in these demographics by such an extreme factor. The more likely story is that deaths of despair really are taking a bite. Given my review of the CDC data and the close match between the official covid counts and "excess mortality" estimates for 2020, I would guess that there isn't a serious misclassification problem for that year. But there is more to do when the 2021 data becomes available. It's possible that excess deaths due to deaths of despair and disrupted healthcare take a bigger bite later in the pandemic, but these could be concurrent with a reporting bias that over-attributes deaths to covid. Someone could look at covid deaths versus "excess mortality" by month of the year or age or race to see if there are serious mismatches, which could suggest a reporting bias. (See the link above, excess mortality in the younger demographics far exceeds the official covid count, so obviously it's not straightforward to say "excess mortality can all be attributed to covid" as some careless commentators have done.) Overall I'm fairly confident that the official counts aren't wildly off. There have probably been around 1 million covid-related deaths in the US since the start of the pandemic. But it's worth checking. Official narratives have been wrong before.
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I think we have to start getting really sophisticated about what "excess deaths" means in the current environment. Has anyone projected out what's expected to happen in coming years? Didn't covid kill off a lot of vulnerable people, who would have died anyway within the next few years? Won't this cause overall mortality rates to fall in future years? Are "long covid" or disrupted healthcare or deaths of despair taking enough of a bite that it's overwhelming this expected decline in mortality? I think someone would have to build a reasonably sophisticated statistical model to do this, accounting for mortality at various ages by various conditions, aging the population to project out to future years. "Excess mortality" requires having an expected baseline to measure the actual deaths against. It's probably valid to compare mortality in 2019 to 2020 or 2021 and call the difference "excess mortality", but the further you go into the future the more you have to adjust the baseline and the more assumptions you need to build in.
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