More on Death Rates

By March 28, 2020 Commentary

Obviously the worst effect from coronavirus is death.  The per capita death rate is very low in the United States at this point, but will grow as additional deaths occur.  But there is a need to be careful in assuming that the reported number of deaths attributed to coronavirus is accurate at this point.  Currently, deaths are attributed to coronavirus if that reason is listed on a death certificate or from other reporting methods.  But it is likely there is over-attribution.  A study in Italy, which has reported very high death numbers, suggests some of these issues.  (Italy Issues)  Although not like Italy, some of the same issues may be present in attribution of deaths in the United States to coronavirus.

At some point epidemiologists will do a retrospective study comparing death certificates to actual medical records and the number of deaths attributed to coronavirus will almost certainly be reduced. At some point also, we will be able to look at the underlying death rate trend in an extended period before the epidemic began and compare it with the trend during the epidemic. That will be one method to estimate deaths due to coronavirus.  The issue of pre-existing illness and nosocomial (acquired in a health care facility) infections is also of interest in understanding what deaths were caused by coronavirus.

There are also algorithms available that are fairly good at predicting mortality for an individual in the next six months or a year. These algorithms are used by hospitals and others to aid in managing care. So it will be possible to take the population that died and assess the likelihood that these persons would have died in any event in 6 months or a year. Should all those deaths be attributed to coronavirus? Almost certainly not.

Infections acquired while in a health care facility are also worthy of consideration.  These patients went into the facility for a reason other than coronavirus and contracted the virus and/or became infected while there.  This is very likely occurring with some regularity.  In fact, obtaining infections while in a hospital is such a generally significant issue that Medicare has a special program punishing hospitals for excessive rates of hospital-acquired infections.  So if the patient gets coronavirus in a hospital and ends up dying from the infection, would the same death have occurred–would the patient have contracted the disease in the community?  It is a coronavirus death, assuming it is not also affected by the pre-existing illness issue, but seems to be in a different category.

Just items to be aware of in looking at death rates.  In retrospect they are likely to be lower than they appear at this point.

Leave a Reply