Health Department guidelines for filling out death certificates in Vermont instruct doctors to cite COVID-19 as the cause of death even if patients didn’t test positive for the virus. Patients who died with other serious underlying health conditions also are to be classified as having died of the coronavirus.
As the COVID-19 pandemic continues to see hopeful signs of slowing in the United States, many state health departments have given instructions for how to list the cause of death for patients who died with flu-like or respiratory symptoms.
The Vermont Department of Health guidelines for death certification, sent to health care providers and facilities on March 10, show a preference for listing COVID-19, even when patients hadn’t tested positive for the virus, or had other underlying diseases.
The guidance offers multiple scenarios for doctors.
For example, if a patient is presenting with flu-like or respiratory symptoms but has no lab test confirming coronavirus and subsequently dies, the guidance tells doctors to list the cause of death as “Coronavirus Disease 2019 (COVID-19), presumed.”
If a patient has chronic underlying conditions such as diabetes, cardiovascular disease or emphysema, and presents with flu-like or respiratory symptoms but doesn’t test positive for coronavirus and dies, the doctor is to list COVID-19 as the presumed cause of death. The doctor may list the underlying diseases as “contributory conditions.”
If a patient has chronic underlying conditions and presents with flu-like and respiratory symptoms and does test positive for coronavirus, the doctor is to list the cause of death as “Coronavirus Disease 2019 (COVID-19), laboratory confirmed.” The underlying diseases are to be listed as contributory conditions.
Doctors are not instructed to presume influenza or other illnesses are the cause of death.
The guidelines have the potential to artificially inflate the true number of COVID-19 deaths, stoking panic and providing justification for governors who have collapsed their economies and forced residents to follow “stay home, stay safe” orders.
As reported in Politico, New York City on Tuesday saw an alarming spike in coronavirus deaths — from 6,589 to 10,367 — after health officials included 3,778 “presumed” COVID-19 deaths among patients who hadn’t tested positive for the virus. As a result, more than 36% percent of the city’s COVID-19 death toll is comprised of decedents not known to have had the virus.
Ben Truman, the public health communication officer for the Vermont Department of Health, told True North in an email Monday that the 28 Vermont deaths attributed to the coronavirus as of April 13 were “all COVID-19 confirmed cases.”
The preference for getting coronavirus listed on death certificates can be seen at the federal level as well, beginning with the Centers for Disease Control and Prevention. CDC guidelines contain similar language for how deaths may be attributed to the virus.
“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,” the guidelines state.
Other potential causes of death may be labeled as secondary: “If the decedent had other chronic conditions such as COPD or asthma that may have also contributed, these conditions can be reported in Part II.”
Another challenge involves trying to determine if a person who tested positive for coronavirus actually died from it. Many patients who die with COVID-19 also have other grave illnesses that may have been the true cause of death. Notably, the Vermont Health Department’s regular COVID-19 updates have the artfully worded phrase, “death occurring in persons known to have COVID-19. Death certificate may be pending.”
Doctors, politicians, and media personalities are beginning to take note of the unusual preference being given to COVID-19 in state death tolls. A Minnesota physician and state senator, Dr. Scott Jensen, recently told Fox News host Laura Ingraham that CDC guidelines are misleading the public.
“The idea that we are going to allow people to massage and sort of game the numbers is a real issue because we are going to undermine the [public] trust,” he said. “And right now, as we see politicians doing things that aren’t necessarily motivated on fact and science, their trust in politicians is already wearing thin.”
Dr. Annie Bukacek, a board-certified internal medicine physician in Montana with over 30 years experience, echoed that sentiment.
“The real number of COVID-19 deaths are not what most people are told and what they then think. How many people actually died from COVID-19 is anyone’s guess,” she said. “… Based on inaccurate, incomplete data, people are being terrorized by fear-mongers into relinquishing freedoms.”
Alex Berenson, a former New York Times reporter, criticized the death certificate guidelines on Twitter.
“As you sit home watching #COVID death counts spiral, please know the official @CDCgov guidance for coding COVID-related deaths is as follows: any death where the disease ’caused or is *assumed* to have caused or *contributed to* death.’ Confirmed lab tests are not required.”
Across the nation, governments are under pressure to reopen the economy as hospitalization and death rates continue to occur well below initial predictions, and as more than 16 million Americans have filed for unemployment over the past month due to “stay home” orders.
As of of April 15, the United States has 605,390 coronavirus cases and 24,582 related deaths, according to the Centers for Disease Control and Prevention.
By comparison, between 24,000 and 63,000 Americans have died of seasonal flu since Oct. 1, according to the CDC.