| BY JENNIFER CABRERA AND LEN CABRERA
There has been a great deal of debate over whether COVID-19 deaths are being counted correctly. Some people insist that they’re being undercounted, while others believe that they’re being overcounted.
We had the opportunity to review death certificates for some of Florida’s recent COVID-19 deaths, and we can tell you definitively that Florida is counting deaths that were not directly caused by COVID-19.
Public health agencies have a goal of tracking the spread of a reportable disease, and for that reason, guidance was issued in March that any person who tested positive for COVID-19 should be counted as a COVID-19 death. However, the death count is now prominently featured in newscasts and used as a talking point to claim that some governments aren’t “doing enough” to stop the spread of COVID-19. COVID-19 metrics, including the number of reported deaths, are increasingly cited by governments as a reason to write public health recommendations into law.
Specifically, some talking heads and media outlets blame every death in Florida on Governor DeSantis because he has not implemented draconian lockdowns and a statewide mask mandate. (Florida is ranked 11th in the United States in COVID-19 deaths per million; most of the top 10 are still under lockdowns, including the top two, New Jersey and New York.)
Review of reporting guidelines
The Centers for Disease Control and Prevention (CDC) has a Physician’s Handbook on Medical Certification of Death that provides guidance to certifying physicians and medical examiners; the goal is that anyone not involved with the deceased or the event can read the report and clearly understand what led up to the death. The certificate has a clear “manner of death” by category (e.g., natural, homicide, accident, etc.). PART 1 should describe the chain of events that directly caused the death. Line a should be the immediate cause of death, followed by the events that result from the underlying cause, which is listed last. Here is an example from the CDC instructions:
Line a is considered the “mechanism of death,” but the CDC does not require listing a “terminal event” such as cardiac or respiratory arrest. PART 2 lists other significant contributing diseases or conditions that did not result in the underlying cause of death.
Florida House report on COVID deaths
Florida House Speaker Jose Oliva’s staff produced an Analysis of COVID Death Data report on October 12 that reviewed 13,920 death certificates provided by the Florida Department of Health on September 23. Of those records:
- 11,460 list COVID-19 as the immediate underlying cause of death in PART 1.
- 1,204 list COVID-19 as a cause, but not the underlying cause of death.
- 1,254 list COVID-19 as a condition in PART 2, but not a cause of death in PART 1.
- 2 did not list COVID-19 at all.
Of the 11,460 records that listed COVID-19 as the immediate cause of death, 8,058 (70%) listed no other causes. According to the report, these records were completed incorrectly, listing COVID-19 in Line a as the immediate cause of death rather than listing the result of COVID-19, such as pneumonia or acute respiratory disease syndrome (ARDS). While this does not imply the deaths were not caused by COVID-19, incorrectly-filled death certificates do not allow a clear distinction between deaths from COVID-19 and deaths with COVID-19.
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