COVID-19 And Death Certificates

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I recently came across a number of interesting stories that suggest that COVID-19 is less likely a direct cause of death than previously thought. The Centers for Disease Control (CDC) has reported that six percent of death certificates listed COVID-19 as the sole cause of death without other conditions. 94 percent of deaths from the coronavirus had a number of underlying conditions in addition to COVID-19.

The CDC website reads: “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.”

Given what we know about SARS-CoV2’s tendency to more severely affect older and infirm Americans, this is no surprise. We’ve known since the beginning that the older and less healthy you are, the more likely you’ll have a bad case if you’re infected. In many, the virus may have been the final push over the cliff, but it wasn’t what brought them to the edge.

The report underscores the fact that, if we can believe what’s written on the death certificates, COVID-19 is not very lethal to young, healthy people. That doesn’t mean that it hasn’t killed some, but not in the numbers that you might think.

As of August 26, 2020, there were “only” 57 deaths among children 14 and younger, less than have succumbed to influenza this year. I say “only” in a relative sense, as the death of a child for any reason is a tragedy.

Among those 15-24, there have been 280 deaths; 25-34, about 1,250.  This total of about 1600 deaths among under 35s is very troubling, until you realize that they comprise just 1 percent of the 165,000 people whose death certificates have COVID-19 as the cause or contributing factor.

Those entering middle-age (35-44) total about 3,300. Americans edging towards the end of middle age (45-54) equal 8,700. That’s about 5 percent of total deaths.

So, it’s clear that, although you’ll read about tragic COVID-19 cases involving young people, severe disease and death is still mostly an issue for older citizens. Not every senior citizen, however: Those grappling with chronic disease like high blood pressure, heart disease, chronic lung disease, and others are at much greater risk than those older folks who are relatively healthy. In fact, the death rate among those 85 or older is 10.4 percent. That means almost 90% of people 85 years or older will survive the disease.

More than 130,000 65s and over have died with COVID-19 listed on their death certificates (out of 165,000 total deaths) in the U.S so far. If 94 percent of them had multiple other conditions contributing to their demise, the question is: Did all these people die because of the virus or just with the virus?

It’s naive to think that the virus wasn’t the straw that broke camel’s back for many, but certainly not all. Of the 95,000 who died with COVID-19 over the age of 75, it stands to reason that some of them succumbed from their underlying health problems. Others may have died even if they caught a simple cold or flu.

SARS-CoV2 is, of course, something to take very seriously. Have we done all we can for our elderly population, especially those in nursing homes and other assisted-living facilities? Should we concentrate more of our efforts on protecting these elderly and infirm rather than disrupting, perhaps permanently, the lives of young, healthy citizens?

Common sense measures like masks and crowd avoidance are here to stay for the foreseeable future, but most cases of COVID-19 are mild or asymptomatic. Alarmism and panic is in no one’s best interest; in fact, it’s a disservice to society.

Joe Alton MD

Joe Alton MD

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