There’s Nothing Contrived About the Coronavirus Death Toll

‘They would have died anyway’ is a flawed and ugly claim

eople who believe Covid-19 is not a big deal and is something we should just live with, like the flu, argue that the death toll is inflated because many of those who have died were old or had underlying medical conditions and would have died soon anyway.

The argument is not only morally reprehensible but also scientifically flawed, experts say. If a person has a medical condition that puts them at greater risk of complications from Covid-19, and they catch the disease and die, epidemiologists say their death certificate should list Covid-19 as the cause of death.

“People with underlying conditions such as diabetes & high blood pressure who died with Covid also died of Covid because they wouldn’t have died at that point in time without Covid,” Nisreen Alwan, PhD, associate professor in public health at the University of Southampton in England, said on Twitter.

One way Alwan and other epidemiologists measure the causes, trends, and outcomes of a disease is to consider a “counterfactual” scenario. In this case: Would these people have died if Covid-19 didn’t exist?

Researchers at the University of Glasgow in Scotland answered that question with a resounding “not yet.” In a study that has yet to be peer reviewed, the researchers compared the ages of Covid-19 victims to standard measures of life expectancy, while also accounting for their underlying health conditions. The average Covid-19 death subtracted 13 years of life from women and 11 for men.

“If somebody’s been living with heart disease and diabetes and they have Covid-19 in their system… I would suggest that, yes, they died of SARS-CoV-2, of Covid-19 disease,” says Michael Mina, assistant professor of epidemiology at Harvard T.H. Chan School of Public Health. “However, it was probably exacerbated by underlying conditions.”

The average Covid-19 death subtracted 13 years of life from women and 11 for men.

‘Reprehensible’ thinking

While Covid-19 has killed people in all age groups, it is indeed more dangerous for people over age 65 and for anyone with heart disease, diabetes, or obesity. But the idea that people in any of these groups “would have died anyway” is morally offensive to the people dealing with the pandemic daily.

“Frankly, that says there is an acceptable amount of people to lose, which I don’t agree with,” says Saskia Popescu, PhD, an adjunct professor of public health at the University of Arizona and an epidemiologist who said on Monday night that she was exhausted after spending “an overwhelming amount of time reporting new Covid-19 cases to the local health department and reviewing them for employee exposures/contact tracing.” (Arizona is one of several states where new cases are spiking and hospitals are filling up, in advance of what health experts say will be an inevitable resurgence in deaths.)

“People live a long time now, so saying it’s no big deal that somebody died because they were 70 or 75 is reprehensible, because they might have lived until 95 and helped raise grandchildren and contributed a lot to society,” says Sharona Hoffman, JD, a professor of law and bioethics at Case Western Reserve University.

The “would have died anyway” argument is often espoused by the same people who think Covid-19 is not as serious as health officials say it is or that it’s an outright hoax. Those myths have been fed by claims from President Trump that the coronavirus originated in a lab in China and by efforts to downplay the disease by Trump, some state governors, and in conservative media. Social media has only amplified the false claims.

What’s more, an individual’s belief that Covid-19 is “not that bad” can be compounded by a lack of firsthand experience. “People who don’t know anyone who got it or who don’t know anyone who suffered severely because of it are not going to take it as seriously as people who have personal experience with severe cases of the disease,” Hoffman says.

“It’s easy to pick and choose and believe what you want,” Hoffman tells Elemental. She’s referring to confirmation bias, a well-known phenomenon in which people — all of us, in fact — readily take in new information that confirms our preconceived notions and ignore anything that goes against our views.

“People live a long time now, so saying it’s no big deal that somebody died because they were 70 or 75 is reprehensible, because they might have lived until 95 and helped raise grandchildren and contributed a lot to society.”

Politically charged counting complexities

Meanwhile, some people, including President Trump and New York Governor Andrew Cuomo, have questioned the death toll from the coronavirus, and there had been concerns over doctors improperly categorizing too many deaths as Covid-19, either due to lack of concrete information in a case or outright fraud in order to get additional Medicare payments.

To be sure, the volume of deaths has strained states’ reporting systems, and different states use different methods. Doctors and hospitals have been overloaded. Testing for the coronavirus has been incomplete, so sometimes hospitals don’t have all the details they need on a case. Some people die of Covid-19 without ever even going to a hospital.

But any miscounts involve “a tiny percentage of cases,” Hoffman says.

“Even though hospitals are paid more by Medicare for Covid-19 cases, there’s no evidence of fraud,” she says. There are strong disincentives to inflating case counts. “The punishment for fraud is very severe,” Hoffman notes. Plus, states don’t want to see Covid-19 case counts rise, given the negative effect on economic rebooting efforts, and the federal government doesn’t want to make unwarranted payouts.

“Everything is so politically charged, people are looking for excuses to question the data,” Robert Anderson, who oversees the mortality statistics branch of the Centers for Disease Control and Prevention’s National Center for Health Statistics, told the New York Times.

If anything, an undercount

The medical community has settled on Covid-19 being a cause of death for more than 120,000 Americans and more than 470,000 people worldwide, not for the sake of money or politics, but simply because it’s killing people whose time had otherwise not yet come.

“I don’t think cases are being inflated at all,” says Mina, the Harvard epidemiologist. “If anything, the true numbers of infections are underreported.”

Some people have died in private residences and nursing homes without ever being tested for Covid-19, experts say, and before the coronavirus was fully recognized and better understood, some Covid-19 deaths likely got blamed on the flu. Nobody knows the real death toll, but it is “almost certainly” higher than the official count, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said last month in a Senate hearing.

Just look at the math in New York City: Total deaths from March 11 to May 2 were 32,107. Of those cases, 13,831 involved positive tests for Covid-19, according to the CDC. Another 5,048 were called probable Covid-19 cases. However, average deaths for that period in the past six years totaled just 7,935. That means beyond the confirmed and probable Covid-19 deaths, 5,293 additional deaths are unexplained, likely either a direct or indirect result of the pandemic.

“This is a real virus. It’s affecting people in every country,” Mina says, and there’s “nothing contrived” about the death toll. “Anyone who thinks otherwise, I think they need to get out of their social media bubble.”