12-30-2020, 12:52 AM
Here are some real world causes of death in patients who died. All the patients were admitted to a hospital because of COVID-19. The causes of death are listed in decreasing order of frequency.
COVID-19 pneumonia
COVID-19
Respiratory failure
Hypoxia
Septic Shock
Cardio-respiratory arrest
Pneumonia
Cardiac arrest
Multiple organ dysfunction syndrome
Acute respiratory failure
Gastric ulcer hemorrhage
Acute respiratory distress syndrome
Aspiration pneumonia
Pneumothorax
Respiratory arrest
Pulmonary sepsis
Staphylococcal pneumonia
Renal failure
Acute kidney injury
Shock
The total number of deaths in the dataset when I looked at it was 56. Of these, COVID-19 and COVID-19 pneumonia were only the primary cause of death in 17, which left 40 terms other than "COVID-19" or "COVID-19 pneumonia" as the listed primary causes of death (these are the ones "most proximal" to the death). A bunch are directly a result of COVID-19. For example, COVID-19 directly causes hypoxia (low oxygen levels), respiratory failure (the lungs aren't doing their job adequately), acute respiratory distress syndrome (a syndrome that involves a combination of low oxygen levels, and fluid in the lungs that is not due to heart failure, and can be triggered by a lot of different things, including COVID-19), etc. A number of other terms represent the final pathway of dying; either the heart (cardiac arrest) or heart and lungs (cardio-respiratory arrest) give out. Then there are the terms that are complications of COVID-19. For example, a staph pneumonia obviously is not a COVID-19 pneumonia, it is a super-infection (infection on top of another infection). The patient's lungs were weakened by COVID-19 and the normal defense mechanisms which keep Staph out of the lungs failed, and the patient developed a Staph pneumonia. In this case, the Staph pneumonia was a different process (and different organism) than COVID-19, but, the patient almost certainly wouldn't have developed a random Staph pneumonia but for the fact that they had COVID-19 (Staph super-infections are particularly common in patients with influenza; I don't think it is as common with COVID-19, but a viral pneumonia is a well-known predisposing factor. Something like renal failure and acute kidney injury (the patient's kidney's failed) are likely not directly due to COVID-19, but downstream effects, sometimes several steps downstream (a patient gets COVID-19 which sends them to the hospital; they develop a secondary pneumonia from the process I described above. The pneumonia leads to sepsis, an infection in the blood, which in term leads to septic shock and low blood pressure. The low blood pressure means that the kidneys don't get enough blood and go into kidney failure, which, is ultimately what leads to the patient's death. Not all kidney failure is due to COVID-19, and not all COVID-19 leads to kidney failure, but in this case, COVID-19 triggered a cascade of events that led to kidney failure, which proved fatal.
None of these patients would have died had they not gotten COVID-19, so they all should count as COVID-19 deaths.
Another way of looking at things is the number of "excess deaths". The CDC keeps a running count comparing the number of people who died in a given week of the year, compared to historical numbers.
https://www.cdc.gov/nchs/nvss/vsrr/covid...deaths.htm
If you select "Number of Excess Deaths" and select US in the dashboard, you will see that since February 2020 we have had somewhere between 309,000 and 420,000 more deaths of any cause than would be predicted. If a lot of the deaths that had been attributed to COVID-19 had really been patients who died "with COVID" instead of "of COVID" and were being misattributed to COVID-19 because of a positive test, then the number of excess deaths would trail the number of COVID-19 deaths. On the other hand, the other possibility (that some deaths were attributed to a heart attack or non-COVID-19 pneumonia, but were really due to COVID that was missed, which may have happened early in the pandemic), then we would see more excess deaths than COVID-19 deaths, also needs to be considered. The lower bound of the excess deaths (and the uncertainty comes in the fact that it is hard to know exactly how many deaths should have been expected had COVID-19 not happened) is pretty close to the number of COVID-19 deaths (346,000 per Worldometer), especially when you consider that reporting deaths to the CDC can lag a bit (the CDC states that only 60% of deaths are submitted within 10 days of the day of death). On the other hand, the upper bound of the excess deaths number, if accurate, might suggest that either some COVID-19 deaths are being missed, or that people are dying at an increasing rate due to secondary effects of the pandemic (for example, COVID-19 negative people who die because they don't go to the hospital out of concern about catching COVID-19 or patients involved in a motor vehicle collision who are treated inadequately because the hospital doesn't have the resources (like ICU beds) to treat them adequately).
Anyway, the advantage of the excess deaths number is that it doesn't rely on a physician reporting the cause of death "correctly"; anyone who dies who would not have died but for the pandemic will show up as an "excess" mortality figure (there are also a small number of people who were "saved" due to the pandemic, for example, by not driving home drunk from a bar that is now closed and therefore getting into a fatal motor vehicle collision).
BC
COVID-19 pneumonia
COVID-19
Respiratory failure
Hypoxia
Septic Shock
Cardio-respiratory arrest
Pneumonia
Cardiac arrest
Multiple organ dysfunction syndrome
Acute respiratory failure
Gastric ulcer hemorrhage
Acute respiratory distress syndrome
Aspiration pneumonia
Pneumothorax
Respiratory arrest
Pulmonary sepsis
Staphylococcal pneumonia
Renal failure
Acute kidney injury
Shock
The total number of deaths in the dataset when I looked at it was 56. Of these, COVID-19 and COVID-19 pneumonia were only the primary cause of death in 17, which left 40 terms other than "COVID-19" or "COVID-19 pneumonia" as the listed primary causes of death (these are the ones "most proximal" to the death). A bunch are directly a result of COVID-19. For example, COVID-19 directly causes hypoxia (low oxygen levels), respiratory failure (the lungs aren't doing their job adequately), acute respiratory distress syndrome (a syndrome that involves a combination of low oxygen levels, and fluid in the lungs that is not due to heart failure, and can be triggered by a lot of different things, including COVID-19), etc. A number of other terms represent the final pathway of dying; either the heart (cardiac arrest) or heart and lungs (cardio-respiratory arrest) give out. Then there are the terms that are complications of COVID-19. For example, a staph pneumonia obviously is not a COVID-19 pneumonia, it is a super-infection (infection on top of another infection). The patient's lungs were weakened by COVID-19 and the normal defense mechanisms which keep Staph out of the lungs failed, and the patient developed a Staph pneumonia. In this case, the Staph pneumonia was a different process (and different organism) than COVID-19, but, the patient almost certainly wouldn't have developed a random Staph pneumonia but for the fact that they had COVID-19 (Staph super-infections are particularly common in patients with influenza; I don't think it is as common with COVID-19, but a viral pneumonia is a well-known predisposing factor. Something like renal failure and acute kidney injury (the patient's kidney's failed) are likely not directly due to COVID-19, but downstream effects, sometimes several steps downstream (a patient gets COVID-19 which sends them to the hospital; they develop a secondary pneumonia from the process I described above. The pneumonia leads to sepsis, an infection in the blood, which in term leads to septic shock and low blood pressure. The low blood pressure means that the kidneys don't get enough blood and go into kidney failure, which, is ultimately what leads to the patient's death. Not all kidney failure is due to COVID-19, and not all COVID-19 leads to kidney failure, but in this case, COVID-19 triggered a cascade of events that led to kidney failure, which proved fatal.
None of these patients would have died had they not gotten COVID-19, so they all should count as COVID-19 deaths.
Another way of looking at things is the number of "excess deaths". The CDC keeps a running count comparing the number of people who died in a given week of the year, compared to historical numbers.
https://www.cdc.gov/nchs/nvss/vsrr/covid...deaths.htm
If you select "Number of Excess Deaths" and select US in the dashboard, you will see that since February 2020 we have had somewhere between 309,000 and 420,000 more deaths of any cause than would be predicted. If a lot of the deaths that had been attributed to COVID-19 had really been patients who died "with COVID" instead of "of COVID" and were being misattributed to COVID-19 because of a positive test, then the number of excess deaths would trail the number of COVID-19 deaths. On the other hand, the other possibility (that some deaths were attributed to a heart attack or non-COVID-19 pneumonia, but were really due to COVID that was missed, which may have happened early in the pandemic), then we would see more excess deaths than COVID-19 deaths, also needs to be considered. The lower bound of the excess deaths (and the uncertainty comes in the fact that it is hard to know exactly how many deaths should have been expected had COVID-19 not happened) is pretty close to the number of COVID-19 deaths (346,000 per Worldometer), especially when you consider that reporting deaths to the CDC can lag a bit (the CDC states that only 60% of deaths are submitted within 10 days of the day of death). On the other hand, the upper bound of the excess deaths number, if accurate, might suggest that either some COVID-19 deaths are being missed, or that people are dying at an increasing rate due to secondary effects of the pandemic (for example, COVID-19 negative people who die because they don't go to the hospital out of concern about catching COVID-19 or patients involved in a motor vehicle collision who are treated inadequately because the hospital doesn't have the resources (like ICU beds) to treat them adequately).
Anyway, the advantage of the excess deaths number is that it doesn't rely on a physician reporting the cause of death "correctly"; anyone who dies who would not have died but for the pandemic will show up as an "excess" mortality figure (there are also a small number of people who were "saved" due to the pandemic, for example, by not driving home drunk from a bar that is now closed and therefore getting into a fatal motor vehicle collision).
BC