COVID-19 - Cause of Death as a Term of Art

Certain government officials and mainstream journalists manipulate COVID-19 death data to magnify the severity of the pandemic. This involves avoiding question-begging geographical comparisons. For instance, how is it that:  Russia with thrice the population of Italy and a 4,200-kilometre, 29-crossing border with China has had 681 COVID-19 fatalities while Italy, at the nether end of Marco Polo's trek, has had 26,384;  Madrid (population 7 million) has suffered more COVID-19 deaths than Asia's eight most populous countries combined (population 3.6 billion); and, The New Jersey-New York-Boston megalopolis has buried two-thirds of America's COVID-19 fatalities. 

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Many factors contribute to disparities in regional COVID-19 death tallies

Many factors contribute to disparities in regional COVID-19 death tallies; but, the most important relate to guidelines and latitudes given to officials in charge of filling-out Death Certificates (coroners, hospital managers, medico-legal staff etc.).   Intelligent, informed people can disagree over what should appear in a Death Certificate's "Cause of Death" box. Disputes over the aptness of Cause of Death descriptions enliven homicide prosecutions and life insurance lawsuits. Cause of Death descriptions are also political footballs booted about by factions within the medical industry who oft complain their pet diseases go underrepresented.  To philosophers "cause" means "selection." Complex interconnected phenomena pre-exist every event. Distinguishing "background conditions" from "agents of change" is inherently controversial. To proclaim "the" cause of an event is to select one ingredient as the most noteworthy. The Center for Disease Control's (CDC) Deaths and Mortality 2017 collates 2.8 million Death Certificates from across America. "Heart Disease" tops the Cause of Death list with 647,457; followed by "Cancer" with 599,108. "Chronic Lower Respiratory Diseases" comes in fourth with 160,201. "Influenza & Pneumonia" held eighth (55,672).  "Pneumonia" refers to bacterial, viral or fungal infections of the lungs. Invasive micro-organisms inflame lung tissue and stimulate mucus secretion. Subsequent constrictions and obstructions give pneumonia-sufferers breathing difficulties and traumatic coughs. Sufferers may suffocate. 

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"Influenza" refers to viral infections of the respiratory system

Among the thirty pneumonia-causing bacteria we find: streptococcus, staphylococcus, chlamydia and tuberculosis. Before anti-biotics strep featured in 75% of America's pneumonia deaths (now 10%).  "Influenza" refers to viral infections of the respiratory system. Efforts to corral "influenza viruses" taxonomically are bedevilled in part by swarms of rhinoviruses, respiratory syntactical viruses and coronaviruses inhabiting the same ecological niche as influenza viruses and causing the same "flu-like" symptoms. Influenza viruses alone number over 100. Several are serious human health threats. All mutate into novel strains.  Influenza becomes pneumonia when the viral infection settles widely across the lung. Viral pneumonia tends to be milder than bacterial pneumonia.  Pneumonia patients are often simultaneously beset by multiple pathogens. Patients recovering from viral lung infections frequently succumb to deadly bacterial pneumonia. Nowhere is it standard practice to record all pathogens hosted by such deceased. Estimates are made, however. The H1N1pdm09 virus apparently claimed 12,500 Americans in 2009. "Pneumococcal bacteria" killed 3,600 in 2017. Official statistics belie pneumonia's prominent role in death. A follow-up study on 2,287 pneumonia patients found 27% experienced new or worsening heart issues during or after their pneumonia episodes.  If a fatal heart attack occurs during a bout of pneumonia; what caused the death? A 325-patient, multi-hospital study on cancer treatments informs: 

"Cancer patients are more likely to get infections. Pneumonia is the most frequent type of infection in this group and a frequent cause of ICU admission and mortality."

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Why should the mere presence of a pathogen that kills fewer than 0.1% of its hosts warrant automatic registering on death certificates?

If a terminal cancer patient dies during a bout of pneumonia; what caused the death?   The fourth leading cause of death is chronic lung disease encountering acute lung disease (pneumonia). The CDC fathomed these depths in April 2020 with their: Guidance for Certifying Death Due to Coronavirus Disease 2019 (COVID-19) which begins:

"The purpose of this report is to provide guidance to certifiers of death for cases where confirmed or suspected COVID-19 infection resulted in death."

The report gives certifiers of death detailed instructions on how to fill-out Parts 1 and 2 of the Cause of Death box in the standardised, CDC-approved Death Certificate. Popular confusion arises from CDC's dual use of the phrase "Cause of Death." In most CDC communiques "Cause of Death" categories are the likes of "heart disease" and "cancer." On Death Certificates however, such categories cannot be A-listed death causes. They cannot even be "underlying causes."  Cancer, lung disease etc are buried in Part 2: "significant conditions contributing to death." These remain the conventional mortality groupings that the CDC, and other health professionals, normally bandy about. Pandemic response protocols, however, require these conventional categories be restrictively discussed. Information about the overwhelming concentration of COVID-19 fatalities among patients with well-chronicled histories of cardio-vascular disease might inspire scepticism about the necessity for the draconian aspects of the pandemic response effort. The CDC report slow-walks a captive readership through likely scenarios. Regarding COVID-19 deaths the certifier of death shall print neatly, onto Line A of the Cause of Death box's Part 1, the words: "Acute Respiratory Disease Syndrome" (suffocation). The certifier shall then print on Line B of Part 1 (Underlying Causes) either the word "COVID-19" or "Pneumonia." If "Pneumonia" is printed on Line B then "Covid-19" goes on Line C. 

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The world's ruling parties are showing, with the effulgent diversity of an Olympic parade, just how elastic a term of art "COVID-19 death" can be

The CDC implores:

"If COVID-19 played a role in the death, this condition should be specified in the death certificate."

And: 

"In cases where a definite diagnosis of COVID-19 cannot be made but is suspected or likely (e.g. the circumstances are compelling and within reasonable degree of certainty) it is acceptable to report COVID-19 on a death certificate as "probable" or "presumed."" 

In making this guess certifiers should draw on their "knowledge of current disease states and local trends." COVID-19's reputation for lethality increases the number of certifiers of death speculatively listing it on death certificates. Added appearances on death certificates fuels a belief in COVID-19's extreme lethality.  Fortunately, this is a two-edged sword. As more studies find hordes of a-symptomatic COVID-19 hosts, COVID-19's reputation as a killer diminishes. Why should the mere presence of a pathogen that kills fewer than 0.1% of its hosts warrant automatic registering on death certificates? The presumption that the mere presence of COVID-19 establishes COVID-19 as a legitimate, actual "Cause of Death" is erroneous; especially given the scores of common germs known to cause acute respiratory distress and/or pneumonia. Under current protocols a patient could present trace evidence of COVID-19 infection and brazen evidence of strep infection, yet be written-up as a COVID-19 fatality. To test only for COVID-19, and then to count all subsequent deaths of positive-testing patients as "COVID-19 fatalities" is a bureaucratic pincer movement aimed at jacking-up COVID-19's body-count. Focussing testing onto terminal wards facilitates this legerdemain.     Official certifiers of death possess wide discretion in deciding what constitutes a COVID-19 fatality. Certifiers of death are everywhere under the thumb of political parties, each bearing ideologies and agendas. The world's ruling parties are showing, with the effulgent diversity of an Olympic parade, just how elastic a term of art "COVID-19 death" can be.

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Sources 

1. Worldometers.info
2. Corrales-Medina et al. Cardiac Complications in Patients with community-acquired pneumonia; Circulation, January 4, 2012
3. D'Or Institute of Research and Education. Adjustments in the treatment of cancer patients with pneumonia; Science Daily, April 13, 2015
4. Center for Disease Control – Deaths and Mortality
5. Center for Disease Control; Vital Statistics Reporting Guidance: Guidance for Certifying Death Due to Coronavirus Disease 2019 (COVID-19); Report No. 3, April 2020.
6. Organisms that can cause pneumonia
7. Marrie, Thomas. Pneumococcal Pneumonia in Adults. Up to date 
8. CDC Pneumonia
9. CDC 2009 Pandemic
10. CDC 2009 Pandemic Another source

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