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SALT LAKE CITY — The internet was abuzz over the weekend when an updated report from the Centers of Disease Control and Prevention noted that 94% of COVID-19 fatalities from Feb. 1 through Aug. 22 included some comorbid factors.
Another way of looking at that is that doctors didn't list another contributing factor for 6% of 161,392 who reportedly have died from COVID-19 as of that date — either because there wasn't one or because the death certificates weren't complete. As evidenced by an array of online articles and social media posts, people interpreted this data in different ways. It included those who viewed it as COVID-19 deaths were vastly overinflated because someone who died of COVID-19 may have died because of a pre-existing condition instead.
So what do these figures actually tell us about COVID-19 deaths?
The short answer is the data essentially affirms what was believed early on, but it also expands on it. The data tells us that people with pre-existing conditions are more likely to have severe effects or die, said Dr. Todd Vento, an infectious disease physician for Intermountain Healthcare. More importantly, it helps medical experts pinpoint which pre-existing conditions are more likely to lead to hospitalizations or death.
“I think it’s a very good lesson on the good, the bad and the ugly of public health — hopefully, more of a good — on how we capture statistics, how we do surveillance, how we share the information with the community so that we can say what measures are taken to prevent disease, severe illness or death,” he said. “This is basically a crash course in the middle of a pandemic on people understanding what the data means.”
According to a Johns Hopkins University tracker, as of Tuesday, Sept.1, there have been more than 6 million cases and 184,000 COVID-19 deaths in the United States; worldwide, there have been more than 25.6 million cases and over 855,000 deaths.
How COVID-19 deaths are calculated
When someone dies, a clinician or physician will list an immediate cause of death for a state health department’s records. The doctor may then list other things that could be associated with or that the death may be attributed to.
Vento has filed these reports in many states during his career and the process doesn’t change much. He used a hypothetical 30-year-old COVID-19 patient as an example of how this works. In this scenario, the person contracts COVID-19, develops myocarditis and later dies from heart failure.
“What you might see on the death certificate is death due to cardiac arrest from myocarditis from COVID-19 infection. Now what you see is other conditions, right?” he explained.
You can plug in any of the major pre-existing conditions that exist and you’ll end up with the same result if COVID-19 is believed to be the driving factor.
“This is what gets to that 94% number. All this means is they said 6% of the cases of COVID-19-associated death had nothing else listed on the death certificate,” Vento added.
When there was confusion over the state’s coronavirus deaths earlier this year, Dunn clarified that COVID-19 was the main factor for that individual’s death. In blunt words, it’s counted because even though the individual may have had a pre-existing condition, they otherwise would not have died if it weren’t for contracting the coronavirus.
It isn’t specific to COVID-19 either.
Take the flu as an example. The 2019-2020 flu season led to an estimated 24,000 to 62,000 fatalities from October 1, 2019, through April 4. There’s a long list of people more likely to have serious complications of the flu — some that overlap with COVID-19 — and those may end up listed as a comorbidity factor on a death certificate.
“Just like a person who, say, has underlying coronary artery disease or heart disease and they have lung disease, they have a higher risk of having a worse influenza illness just like they have a higher risk for a worse COVID illness,” Vento said. “That’s fairly common with the respiratory virus pathogens.”
It’s the same case for essentially all deaths even outside of viruses, he continued. There can be multiple coinciding factors that led to a death but there’s usually a lead cause. In the case of the CDC report, the leading factor was determined to be COVID-19.
Why the data is important to understanding COVID-19
One of the largest struggles medical experts have dealt with throughout the pandemic is the learning curve. Nobody knew the virus existed and there was absolutely no data on it prior to its discovery at the end of 2019. There was some data available by the time it crossed into the U.S. but not as much as what is known now or will be discovered in the future.
It should be noted that health experts were concerned about the risks for those with pre-existing conditions from nearly the beginning of the pandemic. For example, Dr. Angela Dunn, Utah's state epidemiologist, told KSL.com all the way back on March 11 that “individuals with underlying medical conditions such as asthma or other lung disease are at greater risk for developing severe symptoms of COVID-19.”
Based on the data known at the time, she added that heart diseases also appeared to play comorbid factors. To give an idea how early that was in the pandemic for Utah, the state had just a few cases at that time and Utah Jazz center Rudy Gobert tested positive for COVID-19 later that day — and life as we knew it changed almost overnight.
Older age was another factor for higher risk of severe illness. The list of pre-existing conditions that draw concern from the CDC and Utah Department of Health has grown since then as new data and research comes in almost every day.
Diabetes, severe obesity, chronic kidney or liver disease, cancer and some blood disorders are examples of pre-existing conditions added since then. The list grows because every hospitalization or death piles on new statistics for researchers to sift through. Since 94% of deaths included comorbid factors, it allows doctors to pinpoint pre-existing conditions vulnerable for severe COVID-19 outcomes. This is where the high-risk guidance comes from.
What are big factors outlined from the CDC report? Well, age matters. Nearly 8 in 10 COVID-19 fatalities in the U.S. involved someone 65 or older. People aged 55 to 64 made up 60% of the 33,604 people under 65 who died from COVID-19.
That's not to say young people can't die. Three hundred and thirty people under the age of 24 have died from COVID-19, according to the CDC. Another 1,241 deaths were of people between 25 and 34.
A large chunk of people who died from COVID-19 had respiratory diseases like influenza, pneumonia or adult respiratory distress syndrome listed as comorbid factors — things that developed after COVID-19 or were worsened by it. Circulatory diseases and diabetes also were common comorbid factors with over 20,000 listings.
“It confirms that having these other conditions can make you have a severe infection and even die, and it confirms that (COVID-19 contributed to) all of these deaths,” Vento said.
Since the list is ever-growing and new information is learned every week, he added it’s entirely possible there were COVID-19 deaths not counted when they should have been. That’s because a death may have happened at a time when the ruling physician wasn’t aware that a fatal medical episode, such as a blood clot in the lungs the patient suffered, was caused by COVID-19.
So when you see 94% of COVID-19 deaths included comorbid factors that may include pre-existing conditions, that’s what it means and why that data matters.