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Comment by cronix | Hacker News Reader

Is "pointing out" data considered downplaying? ~5% of deaths had "covid only" while the remaining 95% had other factors with the average having 4 other factors.

From the CDC:

> Table 3 shows the types of health conditions and contributing causes mentioned in conjunction with deaths involving coronavirus disease 2019 (COVID-19). The number of deaths that mention one or more of the conditions indicated is shown for all deaths involving COVID-19 and by age groups. For over 5% of these deaths, COVID-19 was the only cause mentioned on the death certificate. For deaths with conditions or causes in addition to COVID-19, on average, there were 4.0 additional conditions or causes per death...

https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm

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I think where that 5% figure is used incorrectly: if you look at the other factors, they seem to not be "someone had a stroke, caught covid, and died", they're stuff like "Someone had Covid, developed pneumonia and died".

The top "other factors" are (in order): Pneumonia, "everything else", respiratory failure, high blood pressure, diabetes, cardiac arrest, heart disease, acute respiratory distress syndrome, etc.

It's pretty clear to say that far more than 5% died of Covid induced complications, not that they died of "natural" causes and also tested Covid positive. Saying the 5% number is almost certainly abuse of statistics, especially given the notable uptick in mortality in the US.

Many of those 'additional causes" are things caused by COVID-19.

e.g. per that table, out of 560K deaths coded as COVID-19, 257K were also coded as "influenza or pneumonia". That's because Covid causes pneumonia.

Adding to this, pneumonia is merely inflammation of the (aveoli in the) lungs and it is almost always caused by some external factor, such as infection or illness.

Yes, because many of those comorbidities are conditions that people could otherwise live with for decades... and furthermore, at least a couple of those comorbidities listed in that table are caused by COVID-19: pneumonia and respiratory failure.

If an obese person is in a car accident and immediately dies, we say that they died due to the more immediate health event: the car accident. -- even though we know that obese people are more susceptible to death in car accidents.

The relevant question is whether the person would have died anyway, without covid. If not, that's a covid death.

Put another way, people in perfect health shouldn't be the only ones whose covid deaths are counted.

Those other factors like pnuemonia, arrythmia, organ damage, sepsis, etc. are mostly caused by COVID-19.

This is like saying that 0% of people who have contracted HIV have ever died of HIV, they died of other diseases. Well, sure, but what allowed those other diseases to be contracted?

Yes, it's considered downplaying to try and attribute these people's deaths to something that didn't kill them.

If the answer to the question of, "Would this person be alive were it not for COVID?" is "Yes", then COVID killed that person.

You should be able to be fragile and still survive, that isn't an excuse to let someone die.

That's... exactly the point?

Dying with COVID does not mean you would be alive today if you hadn't contracted COVID.

That's what he is attempting to imply is a massive overcounting in the data, but additional conditions that people point out as COVID deaths also having are mostly caused by COVID-19. Oh, they died of viral pneumonia after contracting COVID-19; pretty sure they would be in a different scenario had they not caught COVID-19.

The problem is we don't know, and "both sides" don't seem willing to admit that.

What I can guarantee is that of those 95% who died with COVID, some percentage of them would have died anyway, under almost identical circumstances, except without COVID.

However, it is also true that some of those people would have lived if they hadn't contracted COVID, even though COVID was not the "direct" cause of death. For how much longer, who knows. But certainly not when they did.

In other words: the people saying we should only be counting the 5% direct deaths are wrong, and the people that say we should be counting all 100% who had COVID as deaths from COVID are... also wrong.

We can use deaths-above-replacement (among other things) to determine how many more people died than normal from all causes, and then whittle down the obviously-not-from-contracting-covid deaths from there. The submission goes into very specific detail about how they did this, and they account for many of the potential confounders related to doing this analysis.

I believe we can be much more precise than you're giving us credit for in determining if contracting COVID was the direct cause of someone's death, even with comorbidities.

To be totally honest, when I see someone say, "we can't ever be totally sure" I nearly wholly discount that opinion, because it's very cheap to proffer, almost always true, and of very little value.

It is of immense value to say this when you have people in this very thread saying we might as well count everyone who had COVID as a death from COVID.

Also one of us is confused, and I don't think it is me. From what I've gleaned from this article, the 900,000 figure is not (as you say) "determining if contracting COVID was the direct cause of someone's death", but rather trying to figure out how many people would have died if this had been a "normal" year, i.e. if we could go to a parallel universe and make COVID never exist. This is absolutely not the same thing, as such a scenario will also count deaths as a result of our response to the virus as a death "due to the virus". This is my impression as they seem to be including things like suicide (criteria "c") and people who died because people with actual COVID were taking up hospital beds (criteria "b").

"Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that total COVID-19 deaths equal excess mortality."

I think this is the correct way to think about this problem, as it is likely to be an underestimate, rather than an overestimate.

In other words, counting suicides probably doesn't matter, as the number is very low. The paper says as much: "The main potential increases in excess mortality due to deferred care and increases in drug overdose and depression are hard to quantify at this point or are of a much smaller magnitude."

The paper overall goes into very great detail about what was and wasn't included and why, which is vastly more rigorous than what you seem to be presenting, which is effectively throwing up your hands and saying, "we'll never know!"

Just because we don't know exactly doesn't mean we aren't able to create good estimates. We don't know how many people die of any disease. But if you have a large enough dataset, and analyze it well, you can make good determinations of the approximate scale of each factor. The paper linked in this article does that, and concludes approximately 900,000 died of COVID who would not otherwise.

Two different ideas are being conflated here.

One is the OP's idea, "deaths due to COVID". This idea is "how many people would have died if COVID had never existed". However, what a lot of people hear when you say "deaths due to COVID" is "this is the number of people that died as either a direct or indirect result of having COVID in their system". But that is not the 900,000 number being cited.

It is made even worse by the HN headline, which is "death toll from COVID", which even more strongly implies the above.

How long would you have expected them to remain alive absent COVID? Look at it as a probabilistic spectrum, not a binary choice.

Exactly! So rather than try to puzzle out this undecidable proposition for nearly a million individual deaths, let's just look at aggregate statistics. Did more people die on the whole during the pandemic than we would normally expect? Does that line up with a model that they probably died from covid?

And... that's exactly what the linked article is doing. And yeah, it turns out that all these people (on balance) would indeed still be alive had they not been sick with covid.

The linked article seems to be including suicide as a death resulting from COVID, when the increase in suicides is far more likely to be caused by our response to COVID, not having COVID.

It is definitely not only looking at whether people would have died sans covid in their system.

You think there were a half million excess suicides in the US due to our response to covid? Again, this is just nitpicking at an article that supports a (very obvious) conclusion you find politically inconvenient.

As to whether a suicide due to pandemic-induced depression "counts" as being "caused by the pandemic" or not, isn't exactly the kind of confounding effect you railed against above? Isn't the solution, again, to not demand that we micro-classify every death and simply look at the external effects we can measure?

A conclusion I find politically inconvenient? You have no idea what my politics are, please stop projecting.

To answer your question though, no, they should not be lumped together because they are not the same thing and so the mitigations would've/could've/should've been different. In other words, lumping all these things together as "caused by COVID" is the opposite of useful. For example, you do better next time with deaths due to COVID in your system (category "a") by ramping up vaccination faster/better facemask policy/earlier lockdowns/etc. You can decrease category "b" by having more hospital beds / more healthcare capacity. You can reduce the deaths in category "c" (seemingly suicides) by having lockdowns that aren't up-and-down rollercoasters / better mental healthcare / etc. All of these, though being "due to COVID" should be handled very differently so it is counterproductive to lump them all together.

Again, I think you might be projecting a bit here, because the only reason I can think of that you would want to lump them together is to push a political agenda. Not for any utilitarian reason.

Just wait till you hear about 'eggshell client' in a court of law.

You should be careful how far you go with that reasoning. If someone commits suicide due to loneliness during the lockdown does that mean covid killed that person? In an indirect way sure, covid kill him, but in my view it should not be counted as a covid death. Just taking excess deaths without differentiating these kinds of deaths is going to result in misleading statistics. It will cause people to think a person who did not have covid actually died from getting covid.

I think the person above meant:

>"Would this person be alive were it not [for contracting] for COVID?"

Alive when? Right now? By that logic the Spanish Flu has retroactively become quite harmless. The important question is, how much earlier did someone die because of Covid. 2 weeks of life just aren't worth as much as 50 years.

> Is "pointing out" data considered downplaying?

I'd consider it playing devil's advocate, depending on the scenario. The problem is, these days I often see a lot of bad faith arguments being passed off as "just playing devil's advocate".

You can be obese and diabetic and still live to be 80+ years old. My grandma is both, and will be turning 81 this year.

But if someone who is only 30, but obese and diabetic dies to COVID, it's a pretty damn bad faith argument to try to claim that COVID was not the cause of death.

> Is "pointing out" data considered downplaying? ~5% of deaths had "covid only" while the remaining 95% had other factors with the average having 4 other factors.

Is this a useful metric, though? If covid is the catalyst to cause death with preexisting conditions, is not covid the actual cause of death?

Covid in these cases is an acute condition that is the direct cause of death.

At the end of the day, the question is, how many more deaths happened due to COVID than there would be otherwise. For that answer, we can look at excess mortality (which the article uses), which shows more deaths than the official COVID death tally.

https://ourworldindata.org/excess-mortality-covid

> ~5% of deaths had "covid only" while the remaining 95% had other factors with the average having 4 other factors

Well, I don't even know where to find this kind of data, but your hypothesis could be tested by comparing the number of deaths in 2020 against the number of deaths in 2019, broken down by cause of death.

Thank you, somebody with some sense

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