An Analysis Suggests Overreporting of COVID-19 as an Underlying Cause of Death

COVID-19 Overreported as an Underlying Cause of Death

A recent analysis indicates that COVID-19 may have been reported more frequently than it should have been as an underlying cause of death. This overreporting may have inflated COVID-19 mortality numbers and attributed deaths from other causes to the virus.

Research Aims to Identify True COVID-19 Deaths

In a preprint paper published in Research Gate, researchers aimed to identify who truly died “from” COVID-19 versus who died “with” COVID-19 but were included in U.S. COVID-19 mortality numbers. The researchers calculated an overreporting adjustment factor and compared the ratio of reporting COVID-19 as a multiple—or contributing—cause of death versus an underlying cause of death on death certificates from 2020 to 2022. They also examined how “pneumonia and influenza” were reported on death certificates from 2010 to 2022.

Overreporting Adjustment Factor for Mortality

An overreporting adjustment factor for mortality is a statistical correction applied to mortality data to account for the propensity of certain death counts reported more frequently or inaccurately than others. The researchers chose pneumonia and influenza because the conditions are similar in nature to COVID-19, and they could compare patterns using mortality data before and after the pandemic began in 2020.

COVID-19 Overreported Three Times More Than Influenza and Pneumonia

According to the preprint, data show COVID-19 was systematically overreported as an underlying cause of death during the pandemic by an average of about three times for all ages compared to influenza and pneumonia during the same period. Furthermore, only about one-third of influenza and pneumonia-related deaths were reported as underlying causes, whereas almost all COVID-19-related deaths were reported as “deaths from COVID-19.”

How the US Counts COVID-19 Deaths

Each country has its own criteria for determining what constitutes a COVID-19-related death. The United States uses the World Health Organization’s (WHO) classification system to categorize and code mortality data from death certificates. The WHO defines the underlying cause of death as “the disease or injury which initiated the chain of events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury.”

Overreporting of COVID-19 Deaths

According to the analysis, incentives for recording positive COVID-19 tests may have contributed to an overreporting bias in deaths attributed to COVID-19 compared to other diseases. Since the pandemic's start, COVID-19 deaths have included those who died with COVID-19 and from COVID-19, and more recently, those who died of conditions attributed to long COVID, even if they had not tested positive for the virus in recent months or years.

Criteria for Defining a Disease for Public Health Surveillance

State health departments use the CDC’s standardized surveillance case definition and uniform criteria to define a disease for public health surveillance. They also report COVID-19 cases through the agency’s National Notifiable Diseases Surveillance System. At the beginning of the pandemic, the CDC’s definition of COVID-19 was “very simplistic ,” and health departments recorded anyone with a positive COVID-19 diagnosis at the time of death a COVID-19 death, even if a clear alternative cause of death existed.

Long COVID and COVID-19 Mortality Numbers

The CDC broadly defines long COVID as “signs, symptoms, and conditions that continue to develop after acute COVID-19 infection” that can last for “weeks, months, or years.” The term is also used to refer to post-acute sequelae of SARS-CoV-2 infection (PASC), long-haul COVID, and post-acute COVID-19. The CDC guidance gives a physician or medical examiner discretion to classify long COVID as a COVID-19 fatality, which may affect COVID-19 mortality numbers.

Conclusion

The analysis raises important questions about how COVID-19 deaths are reported and the potential impact of overreporting. It's crucial to have accurate data to inform public health decisions and understand the true impact of the pandemic. What are your thoughts on this matter? Do you think the overreporting of COVID-19 as an underlying cause of death has significantly influenced our understanding of the pandemic's severity? Share this article with your friends and let's discuss. Don't forget to sign up for the Daily Briefing, which is everyday at 6pm.