When someone commits suicide, comorbidities on their death certificate don’t mean they didn’t kill themselves.

Resentment about the political response to the COVID-19 pandemic mustn’t impede our ability to think clearly. Since May 8th, the website of the US Centers for Disease Control (CDC) has discussed the comorbidities of Americans who’ve died. It reads, in part:

For 6% of the deaths, COVID-19 was the only cause mentioned. For deaths with conditions or causes in addition to COVID-19, on average, there were 2.6 additional conditions or causes per death.

That does not mean 94% of US deaths attributed to COVID were caused by something else. US death certificates record extensive information, including whether the deceased is married, pregnant, or has served in the armed forces. A doctor is required to list:

1. the immediate cause of death (described as the “final disease or condition resulting in death'”)
2. medical conditions “leading to the cause” stated above
3. underlying causes of death (defined as “disease or injury that initiated the events resulting in death”)

It’s normal for a death certificate to mention more than one health issue. In the words of a Scottish physician: “You go back over the notes to look for existing medical conditions…death certification is certainly not an exact science. Never was, never will be.”

The fact that most COVID death certificates talk about comorbidities is no surprise. Interpreting this as proof these people died of something else is equivalent to claiming that suicide victims with comorbidities didn’t actually kill themselves.

An article titled Viral claim that only 6% of COVID-19 deaths were caused by the virus is flat-out wrong explains that many people suffering from comorbidities listed by the CDC would have lived years or decades longer had they not contracted this virus. Manageable problems became deadly because COVID showed up. These people were less resilient, their bodies were less equipped to fight off a new threat. But Alzheimer’s didn’t kill them. Nor did their diabetes. Nor did their obesity.

On the face of it, the idea that COVID deaths don’t count if other health issues exist is absurd. How, then, shall we calculate fatalities when a bomb destroys a hospital? Shall we say the death toll was merely 68 medical personnel? That the 434 patients all died of their pre-existing conditions?

Do smart people really want to assert that the 76 souls who perished in a Massachusetts nursing home for military veterans aren’t real COVID deaths – because those individuals were old and frail, anyhow?

In an era of political polarization, discounting hundreds of thousands of deaths is not the path to social harmony. It’s callous. It’s counterproductive. It’s guaranteed to alienate millions of grieving relatives, much of the medical profession, many first responders, and those who remain anxious about the safety of their loved ones in long term care facilities.

One of the blogs I monitor is written by Aesop, the handle for a nurse who works in a Southern California emergency department. He’s ex-military, with plenty of snark, profanity, and testosterone. I read him not for those reasons, but because he’s boots on the ground. His account of what’s going on isn’t filtered by the mainstream media or anyone else.

Way back in April, he ranted at length about the comorbidity question. After discussing obesity, high blood pressure, diabetes, and kidney failure he declared: “NONE of these conditions kills anyone.” But, he says, they make you “a juicier target, and a slower moving prey.”

Select snippets from that post (italics in the original; bold added by me):

Here’s Google Dictionary:

Co-Morbidity: the simultaneous presence of two chronic diseases or conditions in a patient.

…the operative word is presence. I put it to you: Were you ever present when someone died? Were you therefore responsible for their death? Was anybody/everybody else who was present similarly culpable?

…When you get mugged and killed in a robbery, because of a Rolex and a diamond pinkie ring, you die of cardio-respiratory failure from getting shot in the heart. Wealth didn’t kill you…just made you a juicier target.

When you get raped, it’s the rapist who rapes you. You got raped because rapists are evil douchebags, not because of your short skirt and high heels.

Those of you mistakenly or deliberately trying to pretend (co-morbidity = proximate cause of death) are not only wrong…you’re using the excuse that the victim’s skirt was too short, their heels were too high, and they had it coming.

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ADDITIONAL THOUGHTS:

• Let us have empathy for those whose experience of this pandemic differs from our own. I don’t personally know anyone who has died in a traffic accident. But that doesn’t mean such deaths aren’t a source of profound sorrow.
• It’s worth reading a second time what the CDC website actually says. The Comorbidities Table (#3) “shows the types of health conditions and contributing causes.” The CDC acknowledges these are distinct, but its table lumps them together. We therefore have no basis for concluding that every medical condition recorded on a death certificate was considered a cause of death.
• The CDC relies on an examination of death certificates, which takes time. Its table was updated last week, but warns that info eight weeks or older may still be missing. Nevertheless, this table says COVID has claimed 186,101 American lives.
• Six percent is 11,166. Ergo: the number of Americans whose death certificate lists COVID-19 and nothing else is 3.75 times the number killed on September 11, 2001 (2,977). There’s nothing trivial about that many apparently utterly healthy people being struck down.
• According to the Worldometer website, the US COVID death toll currently stands at 209,453.
• Deep wounds have been inflicted on hundreds of thousands of families who weren’t able to spend time in the hospital with dying loved ones, who weren’t able to hold proper funerals, and who were denied the comfort family gatherings provide in times of bereavement.
• It’s unclear how many COVID survivors have suffered life-altering changes to their health. Scarred lungs, damaged kidneys, and continuing fatigue months after being declared ‘recovered’ remain huge concerns.
• Human pathology is complicated. As the ScienceABC website explains, “HIV doesn’t actually kill you.” Rather, it undermines your immune system to the point where you develop infections and cancers you wouldn’t normally get. 30 million people have perished after contracting AIDS. Death certificates strive to capture the whole picture. If they listed only immediate causes of death, AIDS victims would be rendered invisible. Official records would say they’d died of other illnesses when, in fact, HIV/AIDS was the crucial catalyst.
• Subjectivity has always played a role in death certificates. See this Scientific American article from May 2020.
• In this blog post, also from May, a Scottish doctor raises concern about COVID and death certificates in the UK. He additionally provides context: “most people would be somewhat surprised to know that the cause of death, as written on death certificates, is often little more than an educated guess. Most people die when they are old, often over eighty. A post-mortem is very rarely carried out. Which means that, as a doctor, you have a think about the patient’s symptoms in the last two weeks of life or so. You go back over the notes to look for existing medical conditions…death certification is certainly not an exact science. Never was, never will be.”
• The authors of a 2005 article, Death Certificates: Let’s Get It Right, argue that doctors should receive more training in how to accurately complete these documents. They further say that, when 200 medical examiners were invited to indicate the manner of death in 23 scenarios, their determinations agreed closely in only 4 instances, and varied considerably in 6 others.

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