Early in 2020, a highly contagious and deadly coronavirus coming from China began to spread throughout the globe. World leaders turned to epidemiologists for advice on how to project the number of deaths and prevent the spread. They constructed models upon these figures. As a result of this advice, whole cities have been quarantined. Scores of “non-life-essential” businesses are closed, and their workers suddenly unemployed.
Painting a Bleak Picture
Understating the crisis could be fatal. However, there also exists the danger of overstating the threat and painting a bleak picture that will cause panic and despair. Accurate numbers provide a sure way to fighting the virus efficiently.
For this reason, policies for determining coronavirus death now in place need to be changed.
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Dr. Steven Schwartz, the director of the Division of Vital Statistics, devised procedures that doctors are to follow when death certificates include the dreaded term, COVID-19. On March 24, 2020, his office issued COVID-19 Alert No. 2, which included the following protocols:
“COVID-19 should be reported on the death certificate for all decedents [deceased persons] 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” (emphasis added).
Is the Picture Accurate?
When the general public hears about COVID-19 deaths, many assume previously healthy people contracted the virus and died. This perception can generate fear and panic since it conveys everyone is equally vulnerable to the disease.
Dr. Schwartz’s instructions reinforce this perception by inflating the death numbers attributed to COVID-19. Physicians are instructed to assume that COVID-19 as the cause even when a person is already near death from other diseases. No test confirming that finding is needed. The assumption suffices.
A U.S. Standard Certificate of Death lists the primary cause of death in Part I of Item 32. Other contributing causes are listed in Part II. If someone, for example, goes into the hospital with a life-threatening case of pneumonia, it is listed as the primary cause. If the person later contracts another viral infection and dies, the complicating virus is listed in Part II.
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If the same patient contracted COVID-19 under the same conditions, Dr. Schwartz’s instructions place the COVID-19 infection in Part I, regardless of its role in causing the death. The physician has the discretion to list pneumonia in Part I, Part II, or not list it at all. The death is recorded in the statistics of Coronavirus victims released to the public.
Getting an Accurate Picture
The uninformed public accepts the inflated figure. It assumes that COVID-19 kills otherwise healthy people and prompts actions that may or may not be proper in the circumstances.
To get an accurate picture of what is happening in this crisis, Dr. Schwartz’s instructions must be revised to show COVID-19’s role in each death.
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The number of deaths needs to be broken down into those in which COVID-19 was the only known cause and those in which it was a complicating factor.
New instructions should also remove the assumption of infection by requiring a test to determine the actual presence of COVID-19 in the deceased. These numbers would assist both government officials and the public in assessing the true scope of the crisis.
There are two great dangers in overstating the risks of COVID-19. The first is the threat to the mental health of the public caused by panic and stress. The second is the economic harm to vast numbers of families and the nation at large caused by an inadequate and uninformed response to the crisis.
Preventing both these dangers warrants these minor, but essential, changes to the death statistic calculations.