COVID doctors challenge CDC's rules on cause of death, concerned about inflated numbers

Frontline COVID-19 doctors this week have gone public saying they feel pressured to show COVID-19 as cause-of-death on certificates of patients suspected of having the virus when they also have had underlying medical conditions.

Dr. Jonathan Fishbein, a clinical researcher, says the Centers for Disease Control and Prevention, the National Institute for Allergy and Infectious Disease and the World Health Organization have issued “vague if not misguided recommendations that unfortunately have been adopted by national, state and local leaders.” 

“It is absolutely critical that we have accurate data to support decision-makers,” he also told Just the News. “If the data in our assessments included patients who have not definitively tested positive for COVID-19, that provides misleading information to policy-makers.

In cases of pandemics or epidemics, world organizations set the cause-of-death guidelines to create a uniformity among countries and related, international health agencies. 

It is not unusual for the CDC, in conjunction with WHO, to add new codes when a new disease appears.

But it is unusual when there is a new disease and a patient dies and the cause of their death may be their underlying condition like diabetes or congestive heart failure and the doctors are pressured to report the cause of death as COVID-19 instead. 

Such reporting could result in inaccurately inflating the number of virus-related deaths and hurt those drafting public health policy for future pandemics or epidemics.

On March 4, Steven Schwartz, director of Vital Statistics at the CDC’s National Center for Health Statistics released an Alert to hospital administrators to inform them that formal guidance was forthcoming to death certificate certifiers, but that in the meantime, “Coronavirus Disease 2019 or COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death.” 

On March 24, 2020, Schwartz sent out a second Alert addressing the World Health Organization’s new International Classification of Diseases. 

‘“The underlying cause depends upon what and where conditions are reported on the death certificate. However, the rules for coding and selection of the underlying cause of death are expected to result in COVID19 being the underlying cause more often than not,” the report in part states.

“COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death,” Schwartz also wrote. “If the decedent had other chronic conditions such as COPD or asthma that may have also contributed, these conditions can be reported in Part II.” 

“Distinguishing between those nuances is crucial for accurate analysis and appropriately responding to the crisis,” Fishbein said.

Fishbein and his colleagues have in response created an independent survey to collect evidence to evaluate risk factors and treatments for COVID-19, with the expectation of more accurately recording causes of death.  

The reporting tool was developed by Veracuity and the survey is being conducted in partnership with the Alliance for Clinical Research Excellence and Safety (ACRES).