From my friend who is a doctor working on the front lines of this thing in Colorado:
“COVID Update 7/9: The Myth of COVID Profiteering
Lately a lot of really harmful stuff has been spread on the internet about how doctors are "forced" to put COVID on death certificates, or how we doctors are getting kickbacks to say someone has COVID to boost numbers. All of this is usually wrapped up in a desire to divert attention away from COVID (likely because the reality is so stark and miserable), or to obfuscate and justify behaviors which are irresponsible during a pandemic.
Here is an example of what people have been writing: "My sister-in-law's husband died of a massive heart attack on April 3rd and they reported it as COVID. I knew since then that something was wrong and of course paying attention to media as proof...the government is not going to send the GAO after this to verify that the money was spent correctly."
Here's another gem..."2 things: 1. I talked to a guys who said they are paying and forcing doctors to sign all deaths as COVID. 2. A man reported he took his elderly mom in. She fell and hit her head. She did die. They put death as COVID and when my brother came in they wouldn't let him in."
Let's sort some of this out...
Sadly part of my job is to perform a death certificate on patients who die from natural causes. My work is then sent to a nosologist (they actually don't knows-all-agist
..doctor humor) for classification and ultimately recording for official numbers.
I'll start by addressing head on the BS about us getting paid to put COVID on the death certificate. Let me explain what the government did to help hospitals out during COVID. All hospitals live and die by elective surgeries--they are usually insurance pre-approved and basically bank roll the rest of the hospital. Most of the things patients get admitted for (heart attacks, cancer, etc) are money losers. If we don't have the elective surgeries, hospitals would go bankrupt.
Early in the COVID crisis it became clear that all hospitals would need to stop all elective surgeries to preserve PPE and to shunt anesthesia ventilators in the service of COVID patients. EVERY HOSPITAL NATIONALLY WOULD GO BANKRUPT WERE IT NOT THE FEDERAL GOVERNMENT BACKSTOPPING THIS. To that end, if a hospital was willing to accept COVID patients, the government paid hospitals a certain amount. That did not stop the bleeding--hospitals lost billions during the pandemic, but it did keep solvency.
OK...next...labeling patients as COVID. WE DO NOT AS DOCTORS GET COMPENSATED FOR PUTTING COVID IN A DIAGNOSIS LIST. This is the stupidest claim I've seen and it's utter BS. There is no direct or indirect pressure to label a death as being COVID. I see these things and I want to strangle people. No one is pressured (except to under-report in states like FL)--almost all doctors perform their jobs ethically and accurately.
How does cause of death work? First of all, the way the death certificate is written is you must list the most proximate cause of death first, then what caused that cause, then what caused that cause.
So, for example, cardiac arrest is not a cause of death--it is a mechanism of death. However, heart attack is a cause of death and it is caused from atherosclerosis which is caused from hyperlipidemia. This looks like this on a death certificate:
A. Cause of death: Myocardial Infarction (Occurred <5 days of death)
B. Caused by: Atherosclerosis (Occurred 10 years prior to death)
C. Caused by: Hyperlipidemia (Occurred 10 years prior to death)
Then there's a section for other medical conditions that contributed to death (such as anemia, chronic kidney disease, diabetes, etc).
Let's take a look at COVID. COVID causes a lot of problems that lead to death. From strokes, to heart attacks, respiratory failure, and multiorgan failure. Depending upon what caused the death in COVID, that would be labeled first in almost all circumstances.
If a person is dying from cancer (as one of the posts above noted) and their clinical condition WORSENED when they got COVID, then COVID is the cause of death and cancer is listed in the "other medical conditions" section. COVID literally caused the patient to die sooner than they would have from cancer. It would be better to list "Multifocal Pneumonia" as cause A and COVID as cause B, but regardless, if the condition resulted in death faster than the underlying illness, that's why COVID is listed.
Another one--a young person comes in with cardiac arrest and dies. Autopsy only finds COVID but no other cause of death. Therefore, COVID is the ONLY cause of death and appropriately is labelled that way. We do the same thing with influenza, or any other infectious disease.
Here's another thing to know: autopsies only reveal the exact cause of death 10% of the time. They aren't like CSI. The net result is it is up to the clinician to do their best.
We are seeing patients die inexplicably from conditions they normally would not be at risk for. Teenagers dying from strokes (a COVID complication), 20-somethings dying from heart attacks (another COVID complication). COVID is the secondary cause in those cases (listed as "B" above).
The biggest problem is having consensus which diseases are COVID-related when someone dies. Which leads to biases based on the doctors signing the death certificates. Some don't believe COVID caused the deaths, others think all deaths are COVID. It's a very fallible system, sadly. Overall, I believe that across the country the average number of deaths reported zeroes out most of the bias.
That people think COVID isn't doing these things is unfortunately fiction. COVID causes diffuse manifestations and sudden death. All of the examples I saw above are examples where COVID should be on the death certificate.
Please stop spreading misinformation like there's a huge cover up going on. Over 135,000 people have died from COVID in the US. For that to be due to "forcing" and "coercion" financially or otherwise would require a cover up of an order not even possible. Physicians take oaths to uphold standards of care--not all physicians are ethical, but almost all are. Please don't continue to damage the largest global health emergency in modern history with hearsay and BS.”
