While the information below might be a little more technical than most readers might be used to, we strongly encourage reading all the way through, as doing so will give you a strong foundational understanding of how the Covid-19 death toll is generated. We have left out as much commentary as possible to give you Just The Facts. You will also find a link to the source information right under each point.
The National Center for Health Statistics (NCHS) is part of the Centers for Disease Control and Prevention, Department of Health and Human Services.
Source: https://www.cdc.gov/nchs/about/organization.htm
The National Vital Statistics System (NVSS) is the system by which the NCHS collects and disseminates the Nation’s official vital statistics (births, deaths, marriages, divorces, and fetal deaths.) The NVSS provides the nation’s official vital statistics data. These data are provided through contracts between NCHS and vital registration systems operated in the various jurisdictions legally responsible for the registration of vital events.
Source: https://www.cdc.gov/nchs/nvss/about_nvss.htm
On March 4th, 2020 Steven Schwartz, PhD Director – Division of Vital Statistics at NCHS sent out an official notice instructing all medical professionals the following:
“COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death.”
Source: https://www.cdc.gov/nchs/data/nvss/coronavirus/alert-1-guidance-for-certifying-covid-19-deaths.pdf
The International Classification of Diseases (ICD) is the classification used to code and classify mortality data from death certificates.
Source: https://www.cdc.gov/nchs/icd/index.htm
On March 24th, 2020 Steven Schwartz, PhD Director – Division of Vital Statistics at NCHS sent out a second alert stating that the purpose of the alert was:
“to alert you that a newly-introduced ICD code has been implemented to accurately capture mortality data for Coronavirus Disease 2019 (COVID-19) on death certificates.”
Source: https://www.cdc.gov/nchs/data/nvss/coronavirus/Alert-2-New-ICD-code-introduced-for-COVID-19-deaths.pdf?fbclid=IwAR0aMmi5bjnfXwvUZDa8iv6sTPEyXu
Three Important points about this March 24th memo:
- The new ICD code for Coronavirus Disease 2019 (COVID-19) is U07.1
- The same alert explained “The WHO (World Health Organization) has provided a second code, U07.2, for clinical or epidemiological diagnosis of COVID-19 where a laboratory confirmation is inconclusive or not available. Because laboratory test results are not typically reported on death certificates in the U.S., NCHS is NOT planning to implement U07.2 for mortality statistics.”
- The document also outlined a response to the question “Should COVID-19 [U07.1] be reported on the death certificate only with a confirmed test?”
To which it responded: “COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death. (So, no.) 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 (Chronic Obstructive Pulmonary Disease) or asthma that may have also contributed, these conditions can be reported in Part II.”
(An important explanation of Part I and Part II of a Death Certificate follows below in their final memo.)
In April 3rd, 2020 the NCHS sent out it’s final official “Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID–19)“
https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf?fbclid=IwAR0Y0f0Zmv-5JlTUiXZZENzAE0yElEA1iB9710UGtFLFdZLCD2_79al3AcE
Some Important points from the document:
- Part I of a Death Certificate: This section on the death certificate is for reporting the sequence of conditions that led directly to death.
- The UCOD (Underlying Cause Of Death), which is “(a) the disease or injury which initiated the train of morbid events leading directly to death or (b) the circumstances of the accident or violence which produced the fatal injury”, should be reported on the lowest line used in Part I.
- Part II of a Death Certificate: Other significant conditions that contributed to the death, but are not a part of the sequence in Part I, should be reported in Part II. Not all conditions present at the time of death have to be reported—only those conditions that actually contributed to death.
Key-Point: At the end of the day, regardless of anything else in the death certificate, only what is indicated in the lowest line of Part 1 goes on to reflect on the U.S. death statistics as the cause of death. - “In cases where a definite diagnosis of COVID–19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID–19 on a death certificate as “probable” or “presumed.””
Remember, “probable” or “presumed” = ICD Code U07.1 since U07.2 is not being used in the U.S., and U07.1 = Covid-19 as UCOD.
Key-Point: Our death certificates don’t distinguish between “probable or assumed” and laboratory-confirmed, nor do they have a place to indicate “probable or presumed”. - Conclusion: “When a death is due to COVID–19, it is likely the UCOD and thus, it should be reported on the lowest line used in Part I of the death certificate. Ideally, testing for COVID–19 should be conducted, but it is acceptable to report COVID–19 on a death certificate without this confirmation if the circumstances are compelling within a reasonable degree of certainty.”
Key-Point: A lab-confirmed COVID-19 diagnosis is not necessary for it to be recorded as the Cause Of Death.
The Final memo included the following two example scenarios and death certificates where both indicate a COVID-19 Cause Of Death (Lowest line in Part 1 of the certificate):
Scenario 1.
“In this case, the acute respiratory acidosis was the immediate cause of death, so it was reported on line a. The COPD (Chronic Obstructive Pulmonary Disease) and hypertension were contributing causes but were not a part of the causal sequence in Part I, so those conditions were reported in Part II.”
Scenario 2.
“Although no testing was done, the coroner determined that the likely UCOD was COVID–19 given the patient’s symptoms and exposure to an infected individual. Therefore, COVID–19 was reported on the lowest line used in Part I.”
Key-Point: Between 2015-2017:
– An average of 33,587 people each year were recorded to have died of Hypertension,
– An average of 143,899 people each year were recorded to have died of Chronic Lower Respiratory Diseases such as Chronic Obstructive Pulmonary Disease.
– An average of 46,887 people each year were recorded to have died of Influenza & Pneumonia.
Source: https://www.cdc.gov/nchs/nvss/leading-causes-of-death.htm
Given the new NVSS guidelines, Chronic Obstructive Pulmonary Disease, Hypertension, Influenza, Pneumonia and others illnesses will not be attributed to be the Underlying Cause Of Death in patients who died with it so long as COVID-19 is present or is suspected or presumed to be present even without testing or laboratory confirmation.
In fact, it is worth mentioning that on July 2020, the CDC published on their own website that
“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”
Source:
https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm?fbclid=IwAR2_BgZFdWzz3a6k6DuKVIqMpPJ7sWGD2_JnJQQN2Xp9Ec_OzS7TmW8SGxo#Comorbidities
Here is what Dr. Scott Jensen had to say about it. (CLICK HERE TO SEE VIDEO)