It is hard to destroy your own cause and feel righteous while doing so, yet the American left has done it. After more than two centuries at the vanguard of the struggle for freedom, the American left, broadly defined, executed a volte face and embraced anti-working-class policies marketed as purely technical public health measures.
by Christian Parenti
Part 5 - Inflated Death Count?
The Western left justifies its embrace of mandates, lockdowns, and censorship by invoking the dead. The US has the highest reported death rate per hundred thousand of any developed economy. As a friend protested “but, the deaths are real!” Indeed, but how many are actually due to Covid?
The CDC reports that less than 6 percent of Covid deaths had COVID-19 as “the only cause mentioned on the death certificate.” The other 94 percent of deaths occurred “with conditions or causes in addition to COVID-19” and, on average, had “4.0 additional conditions or causes per death.” The death of 84-year-old Colin Powell, who was afflicted with multiple myeloma and Parkinson’s, but whose death was reported as “from” Covid, comes to mind.
The CDC reports that less than 6 percent of Covid deaths had COVID-19 as “the only cause mentioned on the death certificate.” The other 94 percent of deaths occurred “with conditions or causes in addition to COVID-19” and, on average, had “4.0 additional conditions or causes per death.” The death of 84-year-old Colin Powell, who was afflicted with multiple myeloma and Parkinson’s, but whose death was reported as “from” Covid, comes to mind.
It is worth noting that the Covid death count in the US is the highest in the developed world. As the New York Times put it, the “American death toll has set the country apart — and by wider margins than has been broadly recognized.” In fact, the US death toll from the coronavirus “is at least 63 percent higher than in any… other large, wealthy nations.”
In other words, many of these US deaths were people who died with Covid, not of Covid. Any inflation of Covid severity helped stoke the public’s fear. Exactly what portion of the nominal Covid dead are misclassified? I would not venture to say. But during the Omicron wave of 2022 even Rochelle Walensky and a reluctant Anthony Fauci acknowledged that many people who were in hospital and Covid positive were not in the hospital for Covid but with Covid.
In other words, many of these US deaths were people who died with Covid, not of Covid. Any inflation of Covid severity helped stoke the public’s fear. Exactly what portion of the nominal Covid dead are misclassified? I would not venture to say. But during the Omicron wave of 2022 even Rochelle Walensky and a reluctant Anthony Fauci acknowledged that many people who were in hospital and Covid positive were not in the hospital for Covid but with Covid.
Despite the definitive nature of death (you’re either dead or you’re not) its causes are not always so clear. The pathways to mortality from disease are often multiple, overlapping, vague, and open to interpretation. As one coroner told me: “In many deaths from diseases, where you have multiple comorbidities, ten different coroners or physicians could possibly give you 10 different versions of the ‘immediate’ and ‘due to’ causes of death.”
There is a sizable academic literature on the difficulties of determining cause of mortality and the problem of death certificate accuracy. For over a century the problem has remained the same: physicians do not always agree on the cause of death. Papers exploring this topic often attempt to, you might say, “fact check” death certificates. Typically, the methodology involves a panel of physicians reviewing autopsy findings and sometimes the medical charts of deceased patients and from that determining a cause of death. The panel’s findings are then compared to the already existing death certificates. The rate of agreement between the two interpretations is viewed as a measure of accuracy or inaccuracy of the initial determination of cause of death. Very often agreement is as low as 50 percent.
There is a sizable academic literature on the difficulties of determining cause of mortality and the problem of death certificate accuracy. For over a century the problem has remained the same: physicians do not always agree on the cause of death. Papers exploring this topic often attempt to, you might say, “fact check” death certificates. Typically, the methodology involves a panel of physicians reviewing autopsy findings and sometimes the medical charts of deceased patients and from that determining a cause of death. The panel’s findings are then compared to the already existing death certificates. The rate of agreement between the two interpretations is viewed as a measure of accuracy or inaccuracy of the initial determination of cause of death. Very often agreement is as low as 50 percent.
One study from 2016 published in the Journal of Epidemiology found “the concordance rate was relatively high for cancer (81%) but low for heart disease (55%) and pneumonia (9%). The overall concordance rate was 48%.” In other words, determining cause of death is as yet still an interpretive art as much as it is a cut-and-dry empirical science.
A chaotic jumble of interacting but uncoordinated government policy and messaging – coming from the White House, federal agencies, Congress, and state governors – have driven an over-classification of deaths as being Covid caused. Directives from the public health establishment compelled state governors to halt elective medical procedures, this created a financial crisis for hospitals. Then, Congress responding to that crisis offered an economic lifeline to healthcare providers in the form of generous economic subsidies and bonus payments for any case that could be classified as Covid.
The timeline runs as follows:
On March 1, 2020, the Centers for Disease Control and Prevention (CDC) issued an “Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States,” which recommended that “inpatient facilities reschedule elective surgeries as necessary and shift elective urgent inpatient diagnostic and surgical procedures to outpatient settings.” With this guidance, governors using their state level emergency powers began ordering the suspension of elective procedures.
Then, on March 18, the Center for Medicare and Medicaid Services (CMS) announced “that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.” Furthermore, CMS recommended that “healthcare providers should encourage patients to remain home, unless there is an emergency.” During early March, almost every governor declared a state of emergency. This meant closing schools, daycares, parks and beaches; mandatory masking; restrictions on out of state travel; restrictions on private gatherings; mandatory 14-day quarantines; full or partial closure of restaurants, bars, and entertainment venues; stay at home or shelter in place orders, and suspension of all elective medical procedures. Thus screening for breast, colorectal, and cervical cancers dropped by 80 percent to 90 percent during March and April of 2020 compared to the same months in 2019. According to one industry analyst, the average hospital lost 40 to 45 percent of their normal operating income.
A chaotic jumble of interacting but uncoordinated government policy and messaging – coming from the White House, federal agencies, Congress, and state governors – have driven an over-classification of deaths as being Covid caused. Directives from the public health establishment compelled state governors to halt elective medical procedures, this created a financial crisis for hospitals. Then, Congress responding to that crisis offered an economic lifeline to healthcare providers in the form of generous economic subsidies and bonus payments for any case that could be classified as Covid.
The timeline runs as follows:
On March 1, 2020, the Centers for Disease Control and Prevention (CDC) issued an “Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States,” which recommended that “inpatient facilities reschedule elective surgeries as necessary and shift elective urgent inpatient diagnostic and surgical procedures to outpatient settings.” With this guidance, governors using their state level emergency powers began ordering the suspension of elective procedures.
Then, on March 18, the Center for Medicare and Medicaid Services (CMS) announced “that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.” Furthermore, CMS recommended that “healthcare providers should encourage patients to remain home, unless there is an emergency.” During early March, almost every governor declared a state of emergency. This meant closing schools, daycares, parks and beaches; mandatory masking; restrictions on out of state travel; restrictions on private gatherings; mandatory 14-day quarantines; full or partial closure of restaurants, bars, and entertainment venues; stay at home or shelter in place orders, and suspension of all elective medical procedures. Thus screening for breast, colorectal, and cervical cancers dropped by 80 percent to 90 percent during March and April of 2020 compared to the same months in 2019. According to one industry analyst, the average hospital lost 40 to 45 percent of their normal operating income.
By the end of April 2020, as a result of these policies, a staggering 1.4 million American healthcare workers had lost their jobs.
The economic crisis ravaging the healthcare system would have been much worse if not for passage of the Coronavirus Aid, Relief, and Economic Security (CARES) Act on March 27, 2020. Among other things, CARES set aside $100 billion for the Provider Relief Fund (PRF), a program designed to support ailing healthcare providers. Money from other bills brought the PRF’s total funding to $178 billion.
Very importantly, the PRF pays 120 percent of costs for any Medicare, Medicaid, or uninsured patients classified as COVID-19 cases. Given the disproportionately older age of those most at risk from Covid, this top-up subsidy covered a large proportion of the cases treated.
The economic crisis ravaging the healthcare system would have been much worse if not for passage of the Coronavirus Aid, Relief, and Economic Security (CARES) Act on March 27, 2020. Among other things, CARES set aside $100 billion for the Provider Relief Fund (PRF), a program designed to support ailing healthcare providers. Money from other bills brought the PRF’s total funding to $178 billion.
Very importantly, the PRF pays 120 percent of costs for any Medicare, Medicaid, or uninsured patients classified as COVID-19 cases. Given the disproportionately older age of those most at risk from Covid, this top-up subsidy covered a large proportion of the cases treated.
At first, this federal Covid money was awarded only for cases confirmed by laboratory-analyzed tests. But CDC guidelines published April 1, 2020, explained that “‘confirmation’ does not require documentation of the type of test performed; the provider’s documentation that the individual has COVID-19 is sufficient.”
The Provider Relief Fund’s FAQ page explains how the money is available “for individuals with possible or actual cases of COVID-19. HHS broadly views every patient as a possible case of COVID-19.” And 35 pages later the same document explains that: “A presumptive case of COVID-19 is a case where a patient’s medical record documentation supports a diagnosis of COVID-19, even if the patient does not have a positive in vitro diagnostic test result in his or her medical record.” As then-Health and Human Services Secretary Alex Azar explained: “Our goal… is to get the money from the Provider Relief Fund out the door as quickly as possible… We will continue using every regulatory and payment flexibility we have to help providers continue doing their vital work.”
The Provider Relief Fund’s FAQ page explains how the money is available “for individuals with possible or actual cases of COVID-19. HHS broadly views every patient as a possible case of COVID-19.” And 35 pages later the same document explains that: “A presumptive case of COVID-19 is a case where a patient’s medical record documentation supports a diagnosis of COVID-19, even if the patient does not have a positive in vitro diagnostic test result in his or her medical record.” As then-Health and Human Services Secretary Alex Azar explained: “Our goal… is to get the money from the Provider Relief Fund out the door as quickly as possible… We will continue using every regulatory and payment flexibility we have to help providers continue doing their vital work.”
On April 13, 2020, the CDC updated its website to say explicitly that “cases where the infection was not confirmed by a test may now be counted.” The CDC page from April 14, 2020, explained that its death counts “include both confirmed and presumptive positive cases…” As the Washington Post reported, “when New York City authorities began reporting the deaths of people who were suspected of having covid-19 but never tested…” the city’s “tally soared past 10,000 as the change added more than 3,700 fatalities.”
Thus, by April CDC guidance and the Provider Relief Fund’s rules allowed financial coverage for cases that were not tested but were merely diagnosed or even “presumed” to be Covid.
Thus, by April CDC guidance and the Provider Relief Fund’s rules allowed financial coverage for cases that were not tested but were merely diagnosed or even “presumed” to be Covid.
FEMA even offers financial assistance for Covid-related funeral arrangements. To qualify the death certificate must “attribute the death directly or indirectly to COVID-19” or “be accompanied by a signed statement from the original certifier of the death certificate or the local medical examiner or coroner from the jurisdiction in which the death occurred listing COVID-19 as a cause or contributing cause of death.” For deaths occurring “on or after May 17, 2020, the death certificate must attribute the death directly or indirectly to COVID-19.” The FAQ section of the same webpage says “you may receive at a maximum of $9,000 per deceased individual.”
In other words, the government forced an economic crisis upon the healthcare system with one hand, while simultaneously offering an economic lifeline, in the form of Covid specific reimbursement, with the other.
I am not charging conspiracy or mass fraud, although there have been a number of indictments. Rather, I am suggesting that the policies described above – arrived at in an uncoordinated and ad hoc fashion by different branches of government during a confusing moment of emergency – created significant economic and bureaucratic incentives for medical examiners and coroners to be expansive in their interpretation of which deaths qualify as Covid deaths.
I am not charging conspiracy or mass fraud, although there have been a number of indictments. Rather, I am suggesting that the policies described above – arrived at in an uncoordinated and ad hoc fashion by different branches of government during a confusing moment of emergency – created significant economic and bureaucratic incentives for medical examiners and coroners to be expansive in their interpretation of which deaths qualify as Covid deaths.
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