guidelines<\/a>, which say to count only deaths \u201cresulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma). There should be no period of complete recovery from COVID-19 between illness and death. A death due to COVID-19 may not be attributed to another disease (e.g. cancer).\u201d<\/p>\nUnlike the CDC, the WHO specifies that COVID-19 listed in PART 2 is not considered a COVID-19 death. These examples are in their guidelines:<\/p>\nOur review of death certificates on October 22, 2020<\/strong><\/p>\nWe were provided with Florida\u2019s COVID death certificates, but we only had a few hours to review them, so we started with a stack from October. We reviewed about 700 (heavily redacted) death certificates. Here is a summary of our findings:<\/p>\n
\nAbout 15% were \u201clazy\u201d (i.e., only listed COVID-19 on Line a, usually without any other entries in PART 1 or PART 2). It is highly unlikely that COVID-19 patients had no other conditions contributing to their death, especially for individuals aged 75 and older, who usually have multiple pre-existing medical conditions. Also, a typical progression for a COVID-19 death in PART 1 would look something like \u201ca. Acute Respiratory Distress Syndrome b. Pneumonia c. COVID-19 infection,\u201d with time intervals from onset to death for each line; few of the certificates we reviewed included these time intervals.<\/li>\n About a third were \u201cinteresting\u201d because they either listed COVID-19 in PART 2 (i.e., death with<\/em><\/strong> COVID-19) or listed other significant conditions like renal failure, metastasized cancer, or strokes (i.e., people who would have probably died in the near future regardless<\/em><\/strong> of COVID-19). At least 5 of these were classified as accidents, not natural deaths.<\/li>\nAbout half we classified as \u201cnormal,\u201d meaning they at least listed pneumonia along with COVID-19, even if they did so on the same line in PART 1 and left PART 2 blank.<\/li>\n Over half left PART 2 blank. With a median age of 76 and 81% aged 65 or older, it is highly unlikely that there were no other significant health conditions. The certificates that did not leave PART 2 blank had an average of 3 co-morbidities.<\/li>\n About 10% of the \u201cinteresting\u201d death certificates listed some form of \u201cAdult failure to thrive\u201d or malnutrition. We don\u2019t know how typical this is for elderly death certificates, but it may be related to the isolation imposed on long-term care residents during COVID-19.<\/li>\n Although a few certifying doctors made it clear that they thought the COVID-19 test was incidental (at best) to the death by writing things like \u201cAsymptomatic positive COVID-19 swab\u201d or \u201cCOVID-19 6 months ago,\u201d these deaths were still counted as COVID-19 deaths.<\/li>\n<\/ul>\nExamples<\/strong><\/p>\nHere are some examples of death certificates that were counted as COVID-19 deaths in Florida (each line starts with the age and gender of the decedent; manner of death is \u201cnatural\u201d unless otherwise noted). These are not a representative sample, just some of the ones we found \u201cinteresting\u201d:<\/p>\n
\n84M, PART 1: a. Cerebrovascular accident, b. atherosclerosis, PART 2: COVID-19 pneumonia<\/li>\n 85M, PART 1: a. Ischemic cardiomyopathy, PART 2: Chronic kidney disease, COVID-19<\/li>\n 57M, PART 1: a. Coronary artery disease, PART 2: asymptomatic COVID-19 positive swab<\/li>\n 88M, PART 1: a. Failure to thrive, b. dementia, c. type II diabetes, PART 2: COVID-19 positive<\/li>\n 79F, PART 1: a. renal cancer \u2013 4 months, PART 2: COVID-19<\/li>\n 56F, PART 1: a. complications of paraplegia (non-traumatic), PART 2: Chronic obstructive pulmonary disease, diabetes mellitus, COVID-19<\/li>\n 77F, Accident, PART 1: a. exacerbation of COVID-19 pneumonia, b. prolonged bed rest, c. left femoral neck and pelvic fracture, d. fall, PART 2: fall from standing height<\/li>\n 96M, PART 1: a. hypertensive cardiovascular disease, PART 2: renal insufficiency, anemia, COVID-19<\/li>\n 59M, PART 1: a. cardiorespiratory arrest, b. failure to thrive, c. developmental delay, PART 2: COVID-19, urosepsis<\/li>\n 90F, PART 1: a. cardiopulmonary arrest 2nd to arrhythmia, b. failure to thrive, c. recovered from COVID-19, PART 2: dementia, HTN, hypothyroid<\/li>\n 98F, PART 1: a. Cerebral atherosclerosis, b. vascular dementia without, c. behavioral disturbances, d. COVID-19 positive, PART 2: chronic fatigue, respiratory distress<\/li>\n 74F, Accident, PART 1: a. COVID-19 infection & bronchopulmonary aspergillosis complicating sequelae of blunt force injury of right, PART 2: diabetes, hypertension, cardiovascular disease, obesity<\/li>\n 84F, PART 1: a. Alzheimer\u2019s, PART 2: COVID-19 disease<\/li>\n 88M, PART 1: a. cancer of larynx, PART 2: COVID-19 infection<\/li>\n 85F, PART 1: a. Arteriosclerotic CV disease, PART 2: Atrial fibrillation, COVID-19<\/li>\n 41M, PART 1: a. Cardiac arrest \u2013 immediate b. Respiratory failure, acute on [sic] chronic \u2013 days c. Pulmonary artery hypertension \u2013 years d. Sarcoidosis \u2013 years, PART 2: COVID-19<\/li>\n 69M, PART 1: a. Multiple ischemic strokes, PART 2: Chronic renal failure, recent COVID-19 pneu, dementia<\/li>\n 70M, PART 1: a. Natural causes \u2013 years, PART 2: Neurocognitive (congenital developmental) delay, COVID-19 infection, recurrent aspiration pneumonia<\/li>\n 60M, PART 1: a. Septic shock \u2013 days b. E Coli Bacterium-UTI c. GI bleed \u2013 acute blood loss anemia-esophageal necrosis d. acute hypoxemic respiratory failure, PART 2: Hypertension, HX of COVID<\/li>\n 88F, PART 1: a. Complications of dementia, PART 2: Atrial fibrillation, arteriosclerotic cardiovascular disease, COVID-19<\/li>\n 79F, PART 1: a. Coronary artery disease \u2013 years, PART 2: COVID-19, myeloproliferative disorder, diabetes, Parkinson\u2019s<\/li>\n 83F, Accident, PART 1: a. Complications of COVID-19 \u2013 NS, PART 2: Traumatic brain injury, failure to thrive, atherosclerotic and hypertensive cardiovascular disease, urinary tract infection<\/li>\n 87F, PART 1: a. Senile degeneration of brain, PART 2: Complications related to COVID-19 infection<\/li>\n 98F, PART 1: a. End stage dementia b. Adult failure to thrive c. Positive COVID-19, PART 2: blank<\/li>\n 64M, PART 1: a. Acute heart failure b. Chronic systolic heart failure c. Ischemic cardiomyopathy d. A. Fib, hypertension, HLD, PART 2: COVID-19<\/li>\n 72M, PART 1: a. Parkinson\u2019s disease, PART 2: Hypertension, history of COVID-19 and deep vein thrombosis in July<\/li>\n 89M, PART 1: a. Cardiorespiratory arrest b. Failure to thrive c. Arteriosclerosis cardiovascular disease, PART 2: COVID-19<\/li>\n 82F, PART 1: a. Unknown b. Failure to thrive, depression \u2013 7 days c. Exposure to COVID-19, cough and shortness of breath \u2013 14 days d. Dementia, hypothyroidism, atrial fibrillation, bronchospasm, congestive heart failure \u2013 years, PART 2: History of refusing medications and food for at least 7 days, refusal to go to the emergency room<\/li>\n 77M, PART 1: a. Stage 4 small cell carcinoma of the lung, PART 2: COPD, COVID-19 pneumonia, hypertension<\/li>\n 61M, PART 1: a. Metastasis to liver of unknown origin b. Adenocarcinoma c. COVID-19 d. Severe protein-calorie malnutrition, PART 2: blank<\/li>\n 69F, PART 1: a. Glioblastoma \u2013 months, PART 2: COVID-19 pneu<\/li>\n 78F, PART 1: a. End stage Parkinson\u2019s disease, PART 2: COVID-19 pneu, HTN, CAD<\/li>\n 83M, PART 1: a. Dementia b. Parkinson\u2019s c. B Cell chronic lymphocytic leukemia d. CKD-III, PART 2: COVID-19<\/li>\n 81F, PART 1: a. Small bowel obstruction \u2013 weeks, PART 2: CHF, renal failure, dementia, COVID-19<\/li>\n 62M, PART 1: a. Severe sepsis due to obstructive pneumonia \u2013 5 days b. right lung mass, likely cancer \u2013 60 days, PART 2: Acute renal failure, brain metastasis, COVID-19 infection<\/li>\n 90F, PART 1: a. complications of dementia, PART 2: Arteriosclerotic cardiovascular disease, COVID-19<\/li>\n 76M, PART 1: a. Cardiorespiratory arrest b. End stage renal disease in hemodialysis c. insulin dependent diabetes mellitus, PART 2: Cerebrovascular accident, HTN, hyperlipidemia schizophrenia necrotic sacululcar [sic] COVID-19 infection<\/li>\n 72M, PART 1: a. Esophageal adenocarcinoma with lung and liver metastases, PART 2: COVID-19 pneumonia<\/li>\n 57M, PART 1: a. Myocardial infarction, PART 2: COVID-19 infection<\/li>\n 75M, PART 1: a. End stage ALS, PART 2: Respiratory failure secondary to COVID-19<\/li>\n 94F, PART 1: a. Arteriosclerotic cardiovascular disease, PART 2: Hypertension, dementia, COVID-19<\/li>\n 90F, PART 1: a. Cerebrovascular accident b. Atrial fibrillation, PART 2: COVID (6\/2020)<\/li>\n 87M, PART 1: a. Cardiorespiratory arrest b. dilated cardiomyopathy c. aortic insufficiency\/secondary to AV block d. COPD, PART 2: Parkinson\u2019s, vascular dementia, duodenal ulcer, H\/O COVID+<\/li>\n 92F, PART 1: a. Sequelae of femoral neck fracture b. Blunt impact to extremity, PART 2: Asymptomatic COVID-19 infection, hypertensive heart disease<\/li>\n 65M, PART 1: a. Complications of hepatocellular carcinoma, PART 2: Obesity, COPD, COVID-19, hypertension<\/li>\n 69F, PART 1: a. Complications of urinary tract infection, PART 2: Chronic ethanolism, COVID-19, hypertension, diabetes mellitus<\/li>\n 92F, PART 1: a. Sepsis b. Multidrug resistant bacteremia, PART 2: Decubital wound, COVID-19, dementia, chronic kidney disease stage III, hypertension, diabetes mellitus type II, hyperlipidemia<\/li>\n 94M, PART 1: a. Multiple diseases of the elderly, PART 2: Cerebrovascular disease, vascular dementia, hypertension, chronic lymphocytic leukemia, atrial fibrillation, COVID positivity<\/li>\n 88M, PART 1: a. Multiple diseases of the elderly, PART 2: Cerebrovascular disease with previous strokes, vascular dementia, COVID-19 positivity, hypertension<\/li>\n 61M, PART 1: a. Hepatocellular carcinoma, Hepatitis C, PART 2: COVID-19, non-small cell lung cancer, cirrhosis<\/li>\n 97F, Accident, PART 1: a. Complications of right intertrochanteric femur fracture, PART 2: Hypertensive and arteriosclerotic cardiovascular disease with congestive heart failure, complications of COVID-19<\/li>\n 52F, PART 1: a. Liver failure b. Metastatic disease c. Breast cancer, PART 2: Coagulopathy, septic shock, COVID-19<\/li>\n 80M, PART 1: a. Dementia b. Cerebrovascular disease c. COPD d. Coronary artery disease, PART 2: C19+<\/li>\n 90M, PART 1: a. Octogenarian natural causes b. S\/P C19, PART 2: blank<\/li>\n 97M, PART 1: a. Complications of dementia, PART 2: CKD, COVID-19, Protein calorie malnutrition, Arteriosclerotic cardiovascular disease<\/li>\n 60F, PART 1: a. Intracranial bleed b. End stage liver disease, PART 2: Pneu, COVID-19 positive history, hypertension, cirrhosis, anemia<\/li>\n 89F, Accident, PART 1: a. Complications of hip fracture, PART 2: Cerebrovascular accident, Arteriosclerotic and hypertensive cardiovascular disease, dementia, COVID-19<\/li>\n 91F, PART 1: a. Left hip ORIF repair b. COVID + history c. CABG X 4 vessels d. Heart failure, PART 2: COPD<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-37123","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"http:\/\/stateofthenation.co\/index.php?rest_route=\/wp\/v2\/posts\/37123","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/stateofthenation.co\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/stateofthenation.co\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/stateofthenation.co\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/stateofthenation.co\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=37123"}],"version-history":[{"count":0,"href":"http:\/\/stateofthenation.co\/index.php?rest_route=\/wp\/v2\/posts\/37123\/revisions"}],"wp:attachment":[{"href":"http:\/\/stateofthenation.co\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=37123"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/stateofthenation.co\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=37123"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/stateofthenation.co\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=37123"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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