Cause of death

I keep hearing about people who tested positive for COVID. Omicron is everywhere.

 

Case rates don't mean death rates anymore.

The news in the U.S. seems to track the data from South Africa, where the omicron variant first appeared. Omicron is more contagious than delta, but less lethal.

New York Times

Reality seems to be catching up to ideology. Trump told Americans we might get sick from COVID but wouldn't die. That had not been true for the past twenty months, since previous variants brought infection to the lungs. Omicron settles in the nose and throat. People can still breathe, so omicron has a lower percentage of hospitalization and death. The vaccinated and boosted--even the elderly--get breakthrough omicron infections, but generally have light symptoms. The unvaccinated are doing far worse, but even with them the hospitalization and death rates are low. We may be experiencing a mass immunity event. Some will have immunity from vaccination, some from having gotten the disease and survived, some from both.

U.S. deaths attributed to COVID may reach about one million, at which point mass immunity could cause COVID to fade into the general background rate of deaths that occur naturally in a population. We can hope.

CDC dashboard

The CDC website breaks down excess deaths by age groups, done so for each week of the year in both 2020 and 2021. It showed the deaths against a baseline from pre-COVID years. Something has been killing Americans--primarily older ones--in excess numbers at times coincident with rises in the cases of COVID. Insurance actuaries and keepers of government records know this.

The number of COVID-caused deaths we experience in the next few months will influence policy on what--if anything--government should do to try to curtail COVID's spread. I thought attributing the excess deaths to COVID was obvious. Apparently it is not. This makes attributing a cause of death a ripe subject for political manipulation. 

College classmate Eliot Nierman has posted here before on COVID-related matters. He is a professor of clinical medicine at a University of Pennsylvania teaching hospital. He gave me this heads up.

Eliot Nierman, M.D.

Eliot Nierman, M.D.

Cause of death on death certificates is notoriously unreliable. Having done hundreds if not thousands of death certificates over about 45 years of practice and residency, I can personally confirm that the only reliable statistic is deaths vs expected deaths. That number manages to include deaths of people who avoided care due to COVID worry preventing medical visits and people unable to get care due to overflowing hospitals. 

Death Certificate forms are pretty similar state to state. The problem is that cause of death is hard to answer. Everyone, with the rare exception of brain death and organ transplant, dies because their heart stops. We could say then that cardiac arrest is the cause of death for all of them. Certainly that is what we mean by Sudden Cardiac Death. In all the other cases we are trying to sort out why cardiac arrest happens. Sometimes it is obvious, a gun shot, a heart attack, or COVID pneumonia. But what if you are in the hospital for heart problems, get COVID, then die of a heart attack? What if you have a bad cancer condition, get COVID, and die. Did you die of your cancer or COVID? What if you died at home of a treatable heart arrhythmia or appendicitis but were afraid to go to the hospital because of COVID, or died in the Emergency Room while waiting to be seen because of the backlog from COVID patients. Truly, you died from COVID, but that will not be on the death certificate at all. It honestly often becomes arbitrary. In the outpatient setting where we have less information, it becomes a guess, except when we are expecting death.