Florida Gov. Ron DeSantis (R) recently went on and complained that reports of his state's COVID-19 deaths were greatly exaggerated. He used as an example a person from Orlando who had died in a motorcycle crash. DeSantis said the death "was categorized as a COVID death just because the person had previously tested positive. We've had other incidents in which there's no real relationship, and it's been counted. So, we want to look at that and see how pervasive that issue is as well."
The local CBS affiliate and asked the chief medical examiner for Orange and Osceola counties, Joshua Stephany, MD, about the case. The medical examiner responded that, following the motorcycle crash, "the person was subsequently hospitalized for a long period of time, got pneumonia. It happened to be COVID pneumonia, and they died.... In that case, we did [attribute] it to COVID pneumonia."
It was recently reported that Florida medical examiners are facing a caused by understaffing and budget cuts.
So who decides whether a person has died from COVID-19 or with it? Most death certificates are written by a doctor in a hospital after a patient in their care has died. In some cases, these death certificates are reviewed by the local coroner or medical examiner for accuracy, and to make sure that the patient's death was not due to an accident or injury -- because, by law, accidents, homicides, and suicides have to be investigated by the county, usually with a forensic autopsy.
The death of a motorcyclist who goes to the hospital for treatment of trauma due to a motor vehicle accident would definitely fall under the jurisdiction of the medical examiner. If, however, that motorcyclist had acquired a COVID-19 infection while hospitalized for their injuries -- as in the case cited by Stephany -- then that patient must also be counted as a COVID-19 death.
George Floyd is an example of someone who died with COVID-19, but not of it. The Hennepin County, Minnesota, medical examiner certified Floyd's death as a homicide because he died as a direct result of compression of his chest and neck by police officers. That medical examiner's office was also performing COVID-19 surveillance testing by swabbing all the bodies that came into the morgue for forensic autopsy. Floyd's swab came up positive for SARS-CoV-2, the virus that causes COVID-19, which was noted on his death certificate as an incidental finding -- the virus was present in his body but had not contributed to his death.
Several groups with different agendas have been working to undermine public confidence in the credibility of the COVID-19 death count in the U.S. Their efforts will intensify as the numbers continue to rise.
The death count is a moving target, and news accounts often pit well-meaning doctors and scientists trying to gather the data in rigorous ways against politicians and activists who want to skew the numbers to support foregone conclusions. The death toll from COVID-19 isn't likely to be accurate until years from now when we will have the luxury of looking back at the deaths happening right now in this country and comparing those numbers with those of previous years.
The disparity is called excess mortality. We are starting to get the first reliable data examining excess mortality. In a recent , the number of U.S. deaths due to any cause increased by approximately 122,000 from March 1 to May 30, 2020. That's 28% higher than the reported number of deaths over those same months in previous years and much higher than officially reported COVID-19 death rates for that period. We are certainly undercounting, not overcounting, the victims of this slow-motion disaster.
Excess mortality may not be the most accurate measure, however, because a spike in deaths from an infectious disease like COVID-19 could be partially offset by a drop in deaths as a consequence of people staying home and commerce being reduced under the weight of the pandemic -- car accidents, for instance, are way down.
On the other hand, the numbers could also be reflecting the avoidable deaths of people who die from non-coronavirus natural diseases because they are avoiding going to a hospital for fear of contracting COVID-19, or people who might have survived the event that caused their death if their local hospital hadn't been overwhelmed by COVID-19 cases.
have increased because people are self-medicating or are unemployed, bored, or despondent. Mental illness is on the rise due to the stresses of lockdowns and social isolation. It's even harder to weigh these factors in aggregating the numbers, because the executive branch of the federal government has decided to remove the task of doing so from the scientific professionals at the CDC and give it instead to appointed administrators at the Department of Health and Human Services, resulting in , and allegations of politicization.
Accurate death counts may be months away, but that won't change the reality we are facing today. Our inability to fight this pandemic means that we are watching a thousand Americans die every day. Every day we are watching three jet planes crash and burn, killing everyone aboard, but we don't see it -- only because these people are dying behind the closed doors of hospital wards and nursing homes.
Coroners and medical examiners and epidemiologists are tallying these unnecessary deaths, but sometimes it seems that the numbers just don't mean anything anymore. We have become numb to them. We are complicit and complacent.
But here's why we cannot give in to that despair: It's not too late to fight back against COVID-19. Countries that locked down early and instituted strict public health measures like hand-washing, social distancing, mask-wearing, testing, and contact tracing have done better at battling infection and bringing back their economies than countries that have not. Ignoring the deaths doesn't make them go away.
Playing with the numbers and quibbling over which deaths were due to COVID-19 and which deaths don't count because the decedents were old or had pre-existing conditions doesn't make the death any less significant or important. It doesn't make today's 1,000 avoidable deaths -- or tomorrow's, or the next day's -- any less real to the families who mourn over them. All it does is make us, the living, lose faith in the public institutions that are supposed to keep us safe.
As someone who deals with death on a daily basis, I urge you to stop getting numb to the carnage and to start demanding answers from those with the power to stop it.
, is a forensic pathologist and CEO of PathologyExpert Inc. Her New York Times bestselling memoir, co-authored with her husband, writer T.J. Mitchell, is . They've also embarked on a medical-examiner detective novel series with , now available from Hanover Square Press.