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COVID-19 can lead to death in many ways, for example, by causing pneumonia, respiratory failure, or stroke. Physicians fill out death certificates under strict guidelines, and COVID-19 should not be listed as the cause of death, even if it sets the process in motion. Unfortunately, overburdened physicians sometimes mistakenly list COVID-19 as the cause of death and pneumonia, stroke, and respiratory failure as comorbidities. This reporting error contributes to the misconception that COVID-19 only kills people with multiple comorbidities. In this clip, Dr. Roger Seheult clarifies the ambiguity surrounding how physicians report deaths and comorbidities from COVID-19.
Kyle: Dr. Seheult, could you also speak to this question that some people have, or really the interpretation of something that's on the CDC website about death certificates and how only...at one point, only 5% of death certificates had only COVID-19 on the certificate. I know you fill out quite a few death certificates in the ICU. What are your thoughts on this idea? What can we really interpret from that?
Dr. Seheult: Yeah. So it really boils down to how the death certificate is filled out. Generally speaking, the way the death certificate should be filled out when somebody dies is you have the most proximal thing occur at the top line, and that would be...let's say there was a car accident. Okay. You were in a motor vehicle accident, and as a result of the motor vehicle accident, there was a rupture of one of the internal blood vessels, and then you bled out. So, you wouldn't just put at the top of that death certificate motor vehicle accident. That's not what the bureau of statistics of your state wants to see. They want to see ruptured, you know, pulmonary artery, and then under that, they want to have the reason for the ruptured pulmonary artery. That would be motor vehicle accident. So, when you are describing someone with COVID-19, COVID-19...you don't die from COVID-19, right? COVID-19 is not a final cause of death. It may be the thing that set things in motion, and so you would have COVID-19 caused pneumonia, and then that caused something like adult respiratory distress syndrome or acute respiratory distress syndrome, and that was the cause of death. Because, as we've just mentioned, COVID-19 can cause death in many different ways. COVID-19 could cause you to die by a pulmonary embolism or a stroke in the brain. Unfortunately, some physicians are just putting COVID-19 at the top.
So I think, Kyle, what you're referring to is this statement that we see here on the CDC website, and they say here that "The number of deaths that mention one or more of the conditions indicated is shown for all deaths involving COVID-19 and by age groups." "For over 5% of these deaths, COVID-19 was the only cause mentioned on the death certificate." So people have taken that to mean that really COVID-19 only caused 5% of the 600,000-plus people that have died in this country, and all the other things were just comorbidities. But if you actually look at the CDC's website, you'll see what some of these "comorbidities" are, and as we've just discussed the actual way that COVID-19 kills people. So, for instance, the number one comorbidity was pneumonia. Influenza and pneumonia are grouped together. Well, the pneumonia was caused by COVID-19. It wasn't a comorbidity. Another one that's very common is respiratory failure. Yeah, it's not like people are coming with respiratory failure, and they also happen to have COVID-19. No, COVID-19 causes respiratory failure. And another one of these ones that was on there was adult respiratory distress syndrome. That's actually what they mean to say there's acute respiratory distress syndrome. Again, another thing that's caused by COVID-19. And so what's happening here is that, you know, these physicians are very busy. They're being handed death certificates. They need to fill these things out. They think, "Oh, yeah, that guy, he died of COVID-19. That's right." And they just write COVID-19 at the top. That's the incorrect way of filling those out, and that's the reason why, fortunately, only 5% of those death certificates are being incorrectly filled out with just COVID-19.
Kyle: Just to clarify, using that data to make a case that really COVID-19 is only killing people with multiple comorbidities is not accurate.
Dr. Seheult: Not at all.
An infectious disease caused by the novel coronavirus SARS-CoV-2. COVID-19, or coronavirus disease 2019, was first identified in Wuhan, China, in late 2019. The disease manifests primarily as a lower respiratory illness, but it can affect multiple organ systems, including the cardiovascular, neurological, gastrointestinal, and renal systems. Symptoms include fever, cough, fatigue, shortness of breath, and loss of smell and taste. Some infected persons, especially children, are asymptomatic. Severe complications of COVID-19 include pneumonia, sepsis, acute respiratory distress syndrome, kidney failure, multiple organ dysfunction syndrome, and cytokine storm. Treatments currently involve symptom management and supportive care. Mortality varies by country and region, but approximately 6 percent of people living in the United States who are diagnosed with COVID-19 expire.[1] 1
A compound, CO(NH2)2, occurring in urine and other body fluids as a product of protein metabolism.
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