What is a covid death?

Confusion caused by no consistent definition

After two years one might hope that there was a clear definition of what counted as a covid death. Collateral Global published a report this week exposing how far we are from an agreed definition with numerous different ways to define a covid death.

The confusion arises from our system of death certification. The system has stood the test of time and served the purpose of offering an explanation of death for the family and a broad brush data collection for public health purposes. However, it is not the rigorous system that people seem to think it is. 

The main confusion arises with the two parts of a death certificate. Part 1 lists the train of events that led directly to death ending with the underlying main cause. Part 2 includes any conditions that contributed to the death but were not a necessary part of that train of events. For example, a death from covid pneumonia may have lung cancer added in part 2 as a known risk of developing pneumonia. For the very same death, another doctor may rightly argue that the pneumonia and lung cancer were the direct cause of death and covid, if mentioned at all, should only have been in part 2. For any death there will be a range of opinions among doctors as to how it should be certified. 

When counting covid deaths the measures have included:

  1. Covid as sole cause / Covid as only cause
  2. Due to Covid / Covid as immediate cause
  3. Covid as an underlying cause
  4. Covid as an underlying main cause
  5. Covid as a direct cause
  6. Death involving Covid
  7. Covid mentioned on the death certificate
  8. Covid contributing to death.
  9. Died within 28 days of a Covid test
  10. Died within 60 days of a Covid test
  11. Died within 60 days of a Covid test plus after 60 days with a mention on the death certificate
  12. Covid based on statement of the care home provider

The Collateral global report also noted that half of ‘covid deaths’ in care home had no other condition mentioned on the death certificate which seems highly implausible. They also noted huge variation in the proportion of ‘covid deaths’ where there was a Do Not Resuscitate order in place from 32% in Barts to 85% in neighbouring Kings College London. 

Trying to untangle deaths caused from covid to those caused by policy might be impossible. Fear kept people from seeking the healthcare they needed and this would have resulted in excess deaths. Maximum fear coincided with maximum covid death.

The arbitrary nature of covid death counting also came to the fore this week with the CDC reducing their tally for covid deaths by 72,277 and by 24% in children becauseits algorithm was accidentally counting deaths that were not COVID-19-related.


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