Are We Including ‘All Deaths’ of Coronavirus Patients in the Death Toll, Even If They Died of Something Unrelated?


In a viral tweet Thursday, SpaceX CEO Elon Musk repeated an old claim that everyone with coronavirus who dies is counted as a coronavirus death, even if their death was due to unrelated matters:

The implication is that we are overcounting deaths caused by the virus. The basis for Musk’s claims is a comment made by Dr. Deborah Birx during a coronavirus task force meeting on April 7. “There are other countries that if you had a pre-existing condition and let’s say the virus caused you to go to the ICU and then have a heart or kidney problem — some countries are recording that as a heart issue or a kidney issue and not a COVID-19 death,” said Birx. Misinterpretations like Musk’s caused Birx to clarify what she meant the next day: “So those individuals will have an underlying condition, but that underlying condition did not cause their acute death when it’s related to a COVID infection. In fact, it’s the opposite.” Dr. Anthony Fauci chimed in, calling claims of a padded mortality count “conspiracy stuff.”

The CDC issued guidance for certifying coronavirus deaths in April. The guidance makes it clear that only deaths that were caused by coronavirus can be counted toward the overall mortality rate. Death certificates have two sections for reporting cause of death. The first, Part I, “is for reporting the sequence of conditions that led directly to death,” from the underlying cause of death up until the immediate cause of death. The second section, Part II, is for reporting “Other significant conditions that contributed to the death, but are not a part of the sequence in Part I.”

For example: Coronavirus can cause pneumonia. If a patient died because of pneumonia, pneumonia would be the immediate cause of death while COVID-19 would be the underlying cause of death. It would be accurate to describe such a case as a coronavirus death since the immediate cause of death would not have occurred if the patient did not have coronavirus. Likewise, if a coronavirus patient with a pre-existing condition like heart disease has a fatal heart attack, and the ailment was brought on by coronavirus, the United States classifies the deaths as due to coronavirus, since, while heart disease played a role, the heart attack would not have occurred if the patient had not contracted coronavirus. The CDC guidelines explain: “[Pre-existing] medical conditions do not cause COVID–19, but can increase the risk of contracting a respiratory infection and death, so these conditions should be reported in Part II and not in Part I.”

Recent data indicates that, if anything, coronavirus deaths are being undercounted in the United States. A higher number of deaths than usual have been reported across the country since the pandemic began, and the official tally of coronavirus deaths doesn’t account for the difference between what states usually see this time of year and what they’re experiencing now.

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Photograph of Elon Musk byYasin Ozturk/Anadolu Agency via Getty Images.