I distinctly remember when CNN’s Jim Acosta referred to questioning CDC death counts as a “conspiracy theory” during a Coronavirus Task Force briefing. Oddly he was questioning Dr. Deborah Birx at the time. She went on to explain the deaths were being counted liberally. Because anything that the corporate media dubs a conspiracy generally means there is at least a grain of truth in it, I took a deeper dive at the time.
What I learned is that the CDC was not counting deaths from COVID-19 in the same manner it counts deaths from influenza. In either case an individual does not need to die from the illness to be counted. Rather if it is listed as a contributing factor on the death certificate it is counted. Most deaths list more than one cause so in this way the count is consistent.
However, it is inconsistent in that a death of someone with influenza requires a lab-confirmed test to be counted. A death from COVID-19 does not. The guidance from Steven Schwartz, PhD Director of the Division of Vital Statistics National Center for Health Statistics (NHS) on March 24, 2020, gave significant room for “presumed COVID-19” (emphasis is from the original):
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. Certifiers should include as much detail as possible based on their knowledge of the case, medical records, laboratory testing, etc. If the decedent had other chronic conditions such as COPD or asthma that may have also contributed, these conditions can be reported in Part II. (See attached Guidance for Certifying COVID-19 Deaths)
Additionally, the memo is clear in that as long as the death certificate does not say “pending COVID-19”, the NHS will not follow up to confirm:
What happens if the terms reported on the death certificate indicate uncertainty? If the death certificate reports terms such as “probable COVID-19” or “likely COVID-19,” these terms would be assigned the new ICD code. It Is not likely that NCHS will follow up on these cases. If “pending COVID-19 testing” is reported on the death certificate, this would be considered a pending record. In this scenario, NCHS would expect to receive an updated record, since the code will likely result in R99. In this case, NCHS will ask the states to follow up to verify if test results confirmed that the decedent had COVID19.
This is the liberal counting policy Dr. Birx defended when Acosta questioned her. Now it would appear she has questions about the numbers herself. According to The Washington Post:
During a task force meeting Wednesday, a heated discussion broke out between Deborah Birx, the physician who oversees the administration’s coronavirus response, and Robert Redfield, the director of the Centers for Disease Control and Prevention. Birx and others were frustrated with the CDC’s antiquated system for tracking virus data, which they worried was inflating some statistics — such as mortality rate and case count — by as much as 25 percent, according to four people present for the discussion or later briefed on it. Two senior administration officials said the discussion was not heated.
“There is nothing from the CDC that I can trust,” Birx said, according to two of the people.
Take “heated” out of the characterization, because it is the Post and was denied by officials. However, I share Dr. Birx’s skepticism. Though I do not attribute it to the CDC’s computer systems. Rather, it needs to be attributed to a policy that is too liberal in the face of available testing. Federal reimbursement to hospitals for COVID-19 care may also play a role.
Senator Scott Johnson (R-Minn) has been pointing out the incentive for hospitals to place a COVID-19 diagnosis on television and his own Facebook page:
“Hospital administrators might well want to see COVID-19 attached to a discharge summary or a death certificate. Why? Because if it’s a straightforward, garden-variety pneumonia that a person is admitted to the hospital for – if they’re Medicare – typically, the diagnosis-related group lump sum payment would be $5,000. But if it’s COVID-19 pneumonia, then it’s $13,000, and if that COVID-19 pneumonia patient ends up on a ventilator, it goes up to $39,000.”
He also pointed out some states, like his own and California, list only lab-confirmed cases. New York did not require a lab-confirmed test. Remember when they added a bunch of COVID-19 deaths all on one day? It increased the state’s total deaths by nearly 33%. So, I don’t trust the CDC’s data either and it has nothing to do with the agency’s outdated computer systems.
Dr. Birx could improve reporting and increase confidence in the numbers by insisting that a lab-confirmed case is required to code the death as from COVID-19. The Centers for Medicare and Medicaid Services should also immediately require a lab-confirmed test for reimbursement under the CARES Act. At minimum, current statistics should be presented as confirmed and presumed.
Until the reimbursement requirements are uniform across the country and lab-confirmed deaths are required for inclusion on the death certificate, questioning the death counts is not a conspiracy. In addition to the systems issues the CDC uses, they need to clean up the data they are collecting and make sure it is verified and consistent.
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