On September 23, 2020, the Florida Department of Health gave State House staff 13,920 individual death certificate records for review. These death certificates (see also figure, below) included:
—11,460 records which listed COVID-19 as the immediate or underlying cause of death in PART 1.
—1,204 records that listed COVID-19 as one of the causes in the final sequence of events, but not the underlying cause of death.
—1,254 records listing COVID 19 as a condition that contributed to death in PART 2, but where COVID 19 was not listed as a cause of death in PART 1.
—2 records which did not list COVID-19 in either PART 1 or PART 2 [(car accident; dementia) One must assume these individuals “tested positive” for the virus].
The House investigators averred this initial analysis implied “that the reported COVID deaths are increased by as much as 10% (i.e., presumably 1256/13,920) when contributing conditions are mingled with underlying causes.”
More granular analysis of the 11,460 records designating Covid-19 as the PART 1 immediate or underlying cause of death, revealed:
—8058 of these records listed COVID-19 in Line a, and listed no other causes in any other line of PART 1.
—3697 of these 8058 records specified COVID-19, solely, as both the immediate and underlying cause of death (Line a), even though most of those (all but 246) had other contributing conditions.
—the remaining 4,361 of these 8058 records reported multiple immediate and underlying causes, including COVID-19, in a single line (Line a): 3,756 which listed pneumonia; 265 that listed respiratory failure; 218 which listed pulmonary complications; 175 that listed an assortment of immediate and underlying causes unrelated to COVID 19 (dementia, cancer, stroke, diabetes, etc.)
—1494 records identified COVID-19 as the underlying cause, or starting point, for the chain of events leading to death resulting from one immediate cause.
—1669 records listed COVID 19 as the starting point for the chain of events leading to death resulting from two other causes.
—239 records listed COVID 19 as the starting point for the chain of events leading to death resulting from three other causes.
—nearly 80% of the 11,460 patients died in a hospital. 1,345 of the 11,460 (~12%) died in hospice care, “suggesting an advanced disease state unrelated to but possibly aggravated by COVID.”
—over 81% of the 11,460 deaths occurred in patients aged 65 years, or older.
The Florida House investigators stressed that “nearly 60% [8,058/13.920] of the records classified by the Department of Health,” had “errors,” or were “recorded in a manner inconsistent with state and national guidance.” They also provided evidence, as noted earlier, that ~10% [1,256] of these alleged Covid-19 deaths were misclassified.
I maintain this latter ~10% estimate is far too conservative, and moreover, reflects compliance with the CDC’s April, 2020 Covid-19 death certificate coding guidelines which destroyed the logical firewall between Part 1 “specific cause” of, and Part 2 “contribution(s)” to, individual deaths. Accordingly, to these 1,256 records where Covid-19 is not even listed as the final cause of death, one could add the 175 listing non-Covid-19 immediate and underlying causes, 1,345 occurring in hospice care, and the [3,697-246=] 3451 that somehow classified Covid-19, alone, as both the immediate and underlying cause of death despite acknowledging contributing co-morbidities, or “conditions”. This aggregate mortality total indicates, plausibly, that up to 45% (6,227/13,920) of Florida’s death certificate recorded “Covid-19 deaths” may not merit that classification.
A cover memo (available in full, below) which introduced the Florida House report, written by Speaker José R. Oliva, warned, appositely,
“…national guidelines drive the [Covid-19 death] count up. CDC has determined that the death count should include persons with COVID even if COVID is not an underlying cause of death.”
The Speaker concluded:
“I believe that these two categories are fundamentally different. They should both be noted, but not combined.”
All honest public health, and healthcare professionals, as well as local, state, and national political leaders, should agree with—and abide—Speaker Oliva’s wise, plainspoken observations. Cynical rejection of this counsel, due to modern “political arithmetic,” will distort evidence-based assessment of the Covid-19 outbreak, and compromise rational efforts to resolve it.
“Analysis of COVID Death Data, March 5-September 16, 2020” : pdf links to report’s introductory memo, and full report pdfs, follow.
FL Memo_Analysis of Mortality due to COVID-19 Memo to All Hs Members
