The Blue Öyster Cult, whose public health advisory ‘(Don’t Fear) the Reaper’ still plays in heavy rotation on many US radio stations, botched the daily death rate in the USA. Not 40,000 men and women everyday, nor even 10,000, but a little over 5200 in 1976 – a total of 1,909,440 people died in that leap year – when the track was released, and about 8000 in each of the past three years.
The confirmed CDC figure for 2018 was 2,839,205 deaths in the USA. That was almost a million more than in 1976, but at 8.7 per 1000 people, the general mortality rate has dropped fractionally (from 8.9/1000) in 45 years. In 2019, the provisional total number of deaths was rounded to 2,855,000 (compared to 3,748,000 live births). As of 29 December, provisional data compiled by the Centers for Disease Control and Prevention (CDC) suggest that at least 2,882,500 people have died in the USA in 2020. We can expect the number to increase when the tally is updated in January, and afterwards as delayed death certificates are processed and reported. But by how much?
General data on live births and deaths to the end of June 2020, which captured the first peak of Covid deaths in April and May, suggest the running twelve-month total of deaths in the USA had ticked over 3 million. With an increase in Covid infections and deaths in the last two months of the calendar year, it likely that final figure for 2020 will exceed that, but will be within 10-12% of the usual annual total. This is a large anomaly. The pressing question is, therefore: Can these excess deaths be attributed to Covid-19? Another question is: Should all of these deaths be attributed to Covid-19? The answers are not the same, as I shall explore in another article.
About 10% of 2020 death certificates in the USA have recorded Covid-19 as a cause of death. The formal CDC designation is ‘Deaths with confirmed or presumed COVID-19, coded to ICD-10: U07.1 (COVID-19, virus identified) and U07.2 (COVID-19, virus not identified)’. ICD-10 is the tenth edition of the WHO’s ‘International Classification of Diseases’. CDC reports that ‘For the majority of deaths where COVID-19 is reported on the death certificate (approximately 95%), COVID-19 is selected as the underlying cause of death’. This is a very high percentage – 95% is far higher than in the UK, where the number is closer to 70% – which would only make sense if it were the percentage of people who were hospitalized with severe Covid and subsequently died. However, for reasons that I have set out elsewhere, it includes deaths in every other setting, even where there is no confirmed case of Covid.
Beyond the specifics of death certification, a fierce debate has raged in the USA about whether Covid deaths have been inflated for reasons of politics and profit. The CARES act, passed with strong bipartisan support in the US Congress and signed into law in March, including provisions that guaranteed generous and prompt payments to hospitals and other healthcare providers for all Covid patients they treated, regardless of whether those patients possessed health insurance, or indeed whether they actually had a confirmed Covid diagnosis. According to the CDC’s own guidelines, presumptive Covid and confirmed Covid were to be considered the same for billing purposes. ‘The provider’s documentation that the individual has COVID-19 is sufficient’ and no further proof was needed.
Similarly, billions of dollars were distributed under the terms of the CARES act to nursing homes and other residential care facilities specifically for Covid-related activities. In a system that bills for healthcare services upon delivery the guarantee of ‘free healthcare’ for, and only for, Covid patients, the CARES act and CDC guidelines together created a perverse incentive to inflate Covid numbers.
It is clear that many more people have died this year than should have died. But they did not all die of Covid, and many died because of the response to Covid rather than the disease itself.