What Exactly is a Covid-19 Death?

David Mokotoff, MD
7 min readMay 29, 2020

Different ways of identifying who has actually died from Covid-19 is not as straight forward as it may seem, and the implications are huge

PHOTO: STEPHANIE LECOCQ/SHUTTERSTOCK

There is a common assumption in medical and epidemiology studies. Death is a hard endpoint. Meaning you can’t fudge if someone has died. However, the statistics associated with the coronavirus pandemic has given rise to an all important question. How exactly are Covid-19 “deaths” determined. Conspiracy theorists on both the left and right side of the political spectrum have ignited social media, and presidential health briefings, with accusations that the true death count has been either over or under counted. As a retired physician who has signed hundreds, maybe even thousands, of death certificates during my career, it is not as simple as it may seem. Unless you die from say a bullet to the head, in the end most diseases that result in death do so by having the lungs and or heart give out. In the case of Covid-19, the organ that usually fails and leads to death is the lungs. But death here is due to Covid-19 and not “lung failure.” Death certification differs from state to state, and country to country. However, most death certificates force the doctor to list only one cause of death. Yet they also allow two to three “contributing” causes. For the sake of this discussion, I will deal with only the main cause of death.

How is a Covid-19 death determined?

Many coronavirus patient deaths are easy to determine. Say patient “A” is elderly and in a nursing home. There is a documented outbreak of the virus at the home, and he or she becomes ill. One, or more, Covid-19 swab tests return positive. The patient becomes so sick that they are transferred to a hospital and then an intensive care unit where they have pneumonia and are placed on a ventilator. A few days later they die. Cause of death is Covid-19. It does not matter that they had emphysema, or one lung from cancer, or in the end blood clots in the lung. The cause of death was the virus. For without the viral infection, they might have lived. The others are “secondary” or “contributing” factors. On the other hand, take patient “B” , who is otherwise in good health and comes down with typical Covid symptoms. His doctor orders a swab test and it is positive. He stays home for ten days and is much better. He leaves to go shopping…

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David Mokotoff, MD

David Mokotoff is a retired MD, passionate about health, science, medicine culture, and food, https://tinyurl.com/y7bjoqkd