INDIANAPOLIS — No, 94% of the nation’s deaths attributed to COVID-19 weren’t actually accountable to “something else.”
On Sept. 2, Indiana State Health Commissioner Dr. Kris Box explained a widespread source of misinformation regarding a recent Centers for Disease Control and Prevention dataset about COVID-19 and comorbidities.
When asked about it, Gov. Eric Holcomb laughed and reclined in his chair and asked if any of the many doctors in the room for the statewide COVID-19 news conference wanted to take a crack at it.
“Boy, has it been misinterpreted by social media,” Box said before getting into the details.
State officials were responding to a media question regarding widely circulating social media posts and articles citing a recent CDC report that only 6% of all death certificates listed COVID-19 as the “only cause mentioned.”
The other 94% of deaths contained also at least one other comorbidity — other health condition or symptom — that played a contributing factor in the death. The CDC report indicated that, on average, patients had about 2.5 other health factors involved in their death.
Other health factors listed in tandem included common maladies afflicting a large percentage of Americans such as high blood pressure, obesity or diabetes, while other conditions that were possible were outcomes that likely could develop in someone seriously ill with a respiratory disease like COVID-19 including pneumonia and respiratory failure.
The reported detailed “what death certificates say about deaths from COVID-19,” Box explained and the findings of that report were that most death certificate list other related causes. However, those other causes are contributors with, not conditions solely at fault despite COVID-19, she said.
“In there they mentioned that 6% of the death certificates had only COVID listed as a cause of death, so automatically some of the social media individuals decided well, the other 94% did not die from COVID-19,” Box said, “which is absolutely incorrect.
“It would be like saying that someone that had cancer came in and died of complication maybe of their treatment that they were receiving or lung metastasis or brain metastatic but they also had hypertension or diabetes on their diagnosis on their death certificate so they didn’t die of their cancer. That is absolutely not true,” Box said.
In most causes and for most causes of death it would not be uncommon for people to find multiple contributing factors and conditions listed on a death certificate under the main cause of death.
And that’s what the report says, for the people whose cause of death was COVID-19, these are the other factors doctors have listed as being contributing factors.
“We know physicians or health care providers put down what they see as causes or contributors of an individual’s death,” Box said. “So someone who came in and died of COVID-19 might also have been at higher risk because they had underlying heart disease or lung disease or diabetes or underlying renal failure, but that does not mean that COVID-19 was not a contributing cause to their death.”
Box also explained that the state does not simply tally COVID-19 deaths just because someone claims that what at fault. Indiana’s criteria for labeling something a COVID-19 death has two criteria and it must be both.
The first is that the patient has a certified lab test showing them positive for COVID-19. The second criteria is that COVID-19 must have been a contributing cause to the death.
If a death fails to meet one or both of those, at best it is listed as a “probable death,” which is tracked separately and not included in Indiana’s official death count. As of Sept 3, there were just 220 probable deaths compared to 3,110 confirmed COVID-19 deaths.
“When we get a report of a COVID death we, number one, confirm that there was an infection with COVID-19 by finding that lab report and attaching to it,” Box said. “We look at the death certificate and see what the health care professionals have put down as the causes of death and at the same time we make sure that if there is any questions about that we review that with the health care professional.”
After Box’s explanation, Holcomb, still chuckling at the amount of noise heard about the 6% report, offered any other doctor the opportunity to add to the conversation.
“Does any other doc want to get anything off their chest? This is your opportunity,” Holcomb said.
He had one taker, Indiana Family and Social Services Administration Secretary Dr. Jennifer Sullivan, a pediatric doctor who also described herself Wednesday as a “recovering academic researcher” who worked with these kinds of data sets.
Sullivan praised the data teams across the state that collect and analyze the inflow before it’s release to the public, stating that she believes people would be hard-pressed to find states reviewing the information as rigorously.
Sullivan also brought up the common question of “If a person killed in a motorcycle also had COVID, is it counted as a COVID death?” to which she answered flatly — no.
“This is done very appropriately,” she said. “Comorbidities are really important to understand that that’s all of us. Those are things like high blood pressure, heart disease, asthma other things that make us at higher risk for death and mortality and morbidity.
“If you looked at the pathway to have a COVID death reported by Dr. Box, it is extraordinarily thoughtful with multiple layers to confirm and ensure you’re getting the right data,” Sullivan said.