3 ms·

Can someone address the claim that death certificates coerce doctors to list COVID as the cause of death even if it hasn't been shown definitively to be the cas

Can someone address the claim that death certificates coerce doctors to list COVID as the cause of death even if it hasn't been shown definitively to be the case? Is this a thing?

busymom0 6y ago
Might be something related to this: https://www.usatoday.com/story/news/factcheck/2020/04/24/fact-check-medicare-hospitals-paid-more-covid-19-patients-coronavirus/3000638001/ https://www.usatoday.com/story/news/factcheck/2020/04/24/fac... Also the number of deaths being reported in US includes "probable deaths" which are not confirmed COVID cases. It's even more than the actual confirmed cases. Look at the graph on the last page for NYC for example: https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-deaths-confirmed-probable-daily-04222020.pdf https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-d...
ceejayoz 6y ago
We can make a pretty good estimate of COVID deaths by comparing against past years. There's a clear, large spike - NYC's death rate is six times the average for this time of year. https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html https://www.nytimes.com/interactive/2020/04/21/world/coronav... https://www.nytimes.com/interactive/2020/04/27/upshot/coronavirus-deaths-new-york-city.html https://www.nytimes.com/interactive/2020/04/27/upshot/corona... Giving that we're still low on tests, if someone dies before a test of COVID-like symptoms, it makes sense to consider them a probable (and save the test for someone alive) if deaths are 6x normal - you've got a roughly 5/6 chance of being correct.
- briefcomment 6y ago
  This is interesting. I'm a little confused though. Life expectancy has been on a consistent decline for the last few years, particularly in the US. On top of the declining life expectancy, there should presumably be more people dying as a result of a growing population. In the graphs, they show multiple years. Why do weekly deaths from the last several years, broken out by year, basically look the same?
  - asdfasgasdgasdg 6y ago
    It's gone from 78.8 to 78.5 for males over the last few years, most people think due primarily to the opioid epidemic. And the population of NYC is barely growing, maybe a percent or two a year. These factors you mention aren't even in the same neighborhood as being large enough to explain the data you're reacting to. https://fred.stlouisfed.org/series/SPDYNLE00INUSA https://fred.stlouisfed.org/series/SPDYNLE00INUSA
    - briefcomment 6y ago
      The proportion of the NY population that is over 60 looks like it generally trends higher as time passes. I would imagine a greater proportion are near death as time proceeds because of this. http://alloveralbany.com/images/capital_region_population_age_shift_1990-2015_animated.gif http://alloveralbany.com/images/capital_region_population_ag... https://www1.nyc.gov/assets/planning/download/pdf/planning-level/nyc-population/projections_briefing_booklet.pdf https://www1.nyc.gov/assets/planning/download/pdf/planning-l...
      - asdfasgasdgasdg 6y ago
        So, this is an anti-pattern in conversation, where you come up with an alternate hypothesis to explain something, and then someone tells you your hypothesis is wrong, and then you just jump to another one, and make them work to disprove that as well. What do you have against the obvious explanation? If you have another hypothesis, it would be better to at least do the napkin math and show that you've put in a tiny amount of work, rather than just tossing out random far-fetched stuff. For example, this new hypothesis of yours is even more absurd than the last one, because the relative demographics of New York have not changed much in the past year. It could not explain a large spike in deaths this year.
- jonkho 6y ago
  Couldn’t the spike in nyc deaths be inflated due to the standard operating procedure of using mechanical ventilators for which 9 of 10 patients die [1]? Wasn’t there a big fuss (several articles posted here) about how mechanical ventilators were overused when less invasive methods produced better outcomes, therefore reducing mortality[2]? [1] https://www.bloomberg.com/news/articles/2020-04-22/almost-9-in-10-covid-19-patients-on-ventilators-died-in-study https://www.bloomberg.com/news/articles/2020-04-22/almost-9-... [2] https://www.reuters.com/article/us-health-coronavirus-ventilators-specia/as-virus-advances-doctors-rethink-rush-to-ventilate-idUSKCN2251PE https://www.reuters.com/article/us-health-coronavirus-ventil...
  - briefcomment 6y ago
    Seems like it should be explored further
  - tsbinz 6y ago
    That's kind of incompatible with the critique 2 posts up. They asked if we could have "false positive" deaths because dead people with covid-like symptoms are labeled as covid deaths even when they are not tested (e.g. after dying at home). The people on ventilators were ones in hospitals that were treated as covid patients, those were likely to be tested - and the problem that people on ventilators have a low chance to make it is specific to covid (which is why we are seeing this, ventilators have existed for a long time, usually they don't kill people which is why it became standard operating procedure, unfortunately with covid they seem to trigger something bad ...)
TechBro8615 6y ago
Given that the federal government is paying hospitals between $13,000 (covid patient) and $39,000 (patient on ventilator) for every Coronavirus patient [0], you can see how the incentives might cause hospitals to coerce doctors into listing COVID as cause of death. [0] https://www.politifact.com/factchecks/2020/apr/21/facebook-posts/Fact-check-Hospitals-COVID-19-payments/ https://www.politifact.com/factchecks/2020/apr/21/facebook-p...
- briefcomment 6y ago
  Thanks
- shkkmo 6y ago
  It could be, but the numbers still seem to indicate that covid deaths are under reported, not over reported. The reported number of covid deaths is 30-50% lower than overall increase in mortality compared to historical data.
- dougk16 6y ago
  Of all the "facts" flying around, this one is not only one of the most powerful by itself, but is also (even if it is in some way false) a great distilled example of all the unimaginably strong incentives pulling at the world right now, which I hope gives people an appreciation of how little they can actually know for sure. Even with such a fact slapping you in the face, I mentioned this to someone and the response was basically "hospitals and doctors exist to help people, they would never take advantage of the system like that". There was no continuing the conversation from there. Who knows how reality works, but at the least we've had radically different life experiences if you don't think this could cause the case count to be pulled strongly in the upwards direction away from the actual number. And I'm sure there are other influences pulling it back down, so maybe all the forces are balancing themselves out.
  - briefcomment 6y ago
    People will point out the handful of facts that have convinced them that the situation leans one way, without realizing there's likely a boatload of facts on both sides that are simply too numerous for any one person to gather and make sense of. This is fine, but when people start acting as if the evidence is settled, one way or another, I can't help but despair.

Can someone address the claim that death certificates coerce doctors to list COVID as the cause of death even if it hasn't been shown definitively to be the case? Is this a thing?

busymom0 6y ago

Might be something related to this: https://www.usatoday.com/story/news/factcheck/2020/04/24/fact-check-medicare-hospitals-paid-more-covid-19-patients-coronavirus/3000638001/ https://www.usatoday.com/story/news/factcheck/2020/04/24/fac... Also the number of deaths being reported in US includes "probable deaths" which are not confirmed COVID cases. It's even more than the actual confirmed cases. Look at the graph on the last page for NYC for example: https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-deaths-confirmed-probable-daily-04222020.pdf https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-d...

ceejayoz 6y ago

We can make a pretty good estimate of COVID deaths by comparing against past years. There's a clear, large spike - NYC's death rate is six times the average for this time of year. https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html https://www.nytimes.com/interactive/2020/04/21/world/coronav... https://www.nytimes.com/interactive/2020/04/27/upshot/coronavirus-deaths-new-york-city.html https://www.nytimes.com/interactive/2020/04/27/upshot/corona... Giving that we're still low on tests, if someone dies before a test of COVID-like symptoms, it makes sense to consider them a probable (and save the test for someone alive) if deaths are 6x normal - you've got a roughly 5/6 chance of being correct.

briefcomment 6y ago
This is interesting. I'm a little confused though. Life expectancy has been on a consistent decline for the last few years, particularly in the US. On top of the declining life expectancy, there should presumably be more people dying as a result of a growing population. In the graphs, they show multiple years. Why do weekly deaths from the last several years, broken out by year, basically look the same?
- asdfasgasdgasdg 6y ago
  It's gone from 78.8 to 78.5 for males over the last few years, most people think due primarily to the opioid epidemic. And the population of NYC is barely growing, maybe a percent or two a year. These factors you mention aren't even in the same neighborhood as being large enough to explain the data you're reacting to. https://fred.stlouisfed.org/series/SPDYNLE00INUSA https://fred.stlouisfed.org/series/SPDYNLE00INUSA
  - briefcomment 6y ago
    The proportion of the NY population that is over 60 looks like it generally trends higher as time passes. I would imagine a greater proportion are near death as time proceeds because of this. http://alloveralbany.com/images/capital_region_population_age_shift_1990-2015_animated.gif http://alloveralbany.com/images/capital_region_population_ag... https://www1.nyc.gov/assets/planning/download/pdf/planning-level/nyc-population/projections_briefing_booklet.pdf https://www1.nyc.gov/assets/planning/download/pdf/planning-l...
    - asdfasgasdgasdg 6y ago
      So, this is an anti-pattern in conversation, where you come up with an alternate hypothesis to explain something, and then someone tells you your hypothesis is wrong, and then you just jump to another one, and make them work to disprove that as well. What do you have against the obvious explanation? If you have another hypothesis, it would be better to at least do the napkin math and show that you've put in a tiny amount of work, rather than just tossing out random far-fetched stuff. For example, this new hypothesis of yours is even more absurd than the last one, because the relative demographics of New York have not changed much in the past year. It could not explain a large spike in deaths this year.
jonkho 6y ago
Couldn’t the spike in nyc deaths be inflated due to the standard operating procedure of using mechanical ventilators for which 9 of 10 patients die [1]? Wasn’t there a big fuss (several articles posted here) about how mechanical ventilators were overused when less invasive methods produced better outcomes, therefore reducing mortality[2]? [1] https://www.bloomberg.com/news/articles/2020-04-22/almost-9-in-10-covid-19-patients-on-ventilators-died-in-study https://www.bloomberg.com/news/articles/2020-04-22/almost-9-... [2] https://www.reuters.com/article/us-health-coronavirus-ventilators-specia/as-virus-advances-doctors-rethink-rush-to-ventilate-idUSKCN2251PE https://www.reuters.com/article/us-health-coronavirus-ventil...
- briefcomment 6y ago
  Seems like it should be explored further
- tsbinz 6y ago
  That's kind of incompatible with the critique 2 posts up. They asked if we could have "false positive" deaths because dead people with covid-like symptoms are labeled as covid deaths even when they are not tested (e.g. after dying at home). The people on ventilators were ones in hospitals that were treated as covid patients, those were likely to be tested - and the problem that people on ventilators have a low chance to make it is specific to covid (which is why we are seeing this, ventilators have existed for a long time, usually they don't kill people which is why it became standard operating procedure, unfortunately with covid they seem to trigger something bad ...)

TechBro8615 6y ago

Given that the federal government is paying hospitals between $13,000 (covid patient) and $39,000 (patient on ventilator) for every Coronavirus patient [0], you can see how the incentives might cause hospitals to coerce doctors into listing COVID as cause of death. [0] https://www.politifact.com/factchecks/2020/apr/21/facebook-posts/Fact-check-Hospitals-COVID-19-payments/ https://www.politifact.com/factchecks/2020/apr/21/facebook-p...

briefcomment 6y ago
Thanks
shkkmo 6y ago
It could be, but the numbers still seem to indicate that covid deaths are under reported, not over reported. The reported number of covid deaths is 30-50% lower than overall increase in mortality compared to historical data.
dougk16 6y ago
Of all the "facts" flying around, this one is not only one of the most powerful by itself, but is also (even if it is in some way false) a great distilled example of all the unimaginably strong incentives pulling at the world right now, which I hope gives people an appreciation of how little they can actually know for sure. Even with such a fact slapping you in the face, I mentioned this to someone and the response was basically "hospitals and doctors exist to help people, they would never take advantage of the system like that". There was no continuing the conversation from there. Who knows how reality works, but at the least we've had radically different life experiences if you don't think this could cause the case count to be pulled strongly in the upwards direction away from the actual number. And I'm sure there are other influences pulling it back down, so maybe all the forces are balancing themselves out.
- briefcomment 6y ago
  People will point out the handful of facts that have convinced them that the situation leans one way, without realizing there's likely a boatload of facts on both sides that are simply too numerous for any one person to gather and make sense of. This is fine, but when people start acting as if the evidence is settled, one way or another, I can't help but despair.