Chicago Department of Public Health Commissioner Dr. Allison Arwady on Tuesday addressed questions surrounding what she called misinformation on how coronavirus deaths are being reported.
"There was some misinformation out on social media over the weekend that was pointing to some CDC data," Arwady said. "The CDC data was showing that only 7% of the people who have died of COVID-19 have only had COVID-19. And not any comorbidities, meaning they didn't have diabetes, they didn't have underlying heart disease, lung disease, etc."
According to Arwady, while many people who have died from coronavirus had underlying conditions, she says those conditions are not the cause of their deaths.
"Now, we're all going to die at some point. But somebody who has diabetes or has heart disease would not have died right now, if not for having been infected with COVID-19," Arwady said.
Arwady's comments come as reports on social media claimed the U.S. Centers for Disease Control and Prevention “backpedaled” on the number of deaths caused by COVID-19, reducing the figure from nearly 154,000 to just over 9,000, as social media posts claimed.
The term “Only 6%” trended widely on Twitter over the weekend as supporters of the QAnon conspiracy theory promoted tweets that falsely suggested the CDC had updated its records to show that only 6% of U.S. deaths tied to COVID-19 were legitimate. President Donald Trump was among those who tweeted the information, which was later taken down by Twitter for violating platform rules.
The posts, which received hundreds of thousands of shares online, were based on a regularly updated CDC data table showing underlying conditions for those who died of COVID-19. The conditions included high blood pressure, diabetes and obesity, as well as problems that are caused by COVID-19 itself, such as respiratory failure and pneumonia.
The CDC data table is based on an analysis of death certificates that mention COVID-19 as a cause. For 6% of the deaths, COVID-19 was the only cause mentioned, the CDC notes.
The other 94% list COVID-19 and other conditions together. Among those deaths, there were, on average, 2.6 additional conditions or causes per death, the public health agency said.
As of Aug. 26, the CDC said, there were 161,332 deaths where COVID-19 was listed on the death certificate. Social media users over the weekend posted an older screenshot of the data that showed 153,504 deaths. The posts used the 6% figure to claim the U.S. death toll was much lower — 9,210.
“CDC just backpedaled (quietly) and adjusted the U.S. COVID deaths from 153,504 to 9,210. Admitting that their numbers are so (expletive) that they are off by a whopping 94%,” said a post being shared on Facebook Monday.
But such claims misrepresent the data, experts say. A death isn’t excluded from the COVID-19 tally just because the person was obese or had diabetes or dementia. Someone with heart problems can still be killed by COVID-19, and the death certificate could mention both as contributing.
"What people misinterpreted in this was that somehow because these people also had diabetes, or also had heart disease, they somehow didn't die of COVID as opposed to having the this comorbidity and dying from COVID," Arwady said. "And so this went around and it said, you know, only 7% of the people actually died from COVID."
Experts say it’s not surprising that so few people who died from COVID-19 had no underlying conditions listed on their death certificates. It is rare for people not to have multiple medical issues at death.
“The underlying cause of death is the condition that began the chain of events that ultimately led to the person’s death," Dr. Robert Anderson, who oversees the CDC’s death statistics work, said in a statement. “In 92% of all deaths that mention COVID-19, COVID-19 is listed as the underlying cause of death."
Also, while death certificates are supposed to list any causes or conditions that contributed, past research has shown that the documents aren’t perfect. Doctors might not know – or specify – all the reasons behind a particular death.
"Let's say we take someone who has diabetes and they have heart failure at baseline. So they have a number of these underlying conditions, they get COVID-19, they get admitted to the hospital because they are sick with COVID-19. COVID-19 can go on to make their heart failure worse, maybe it pushes them into having lung problems and respiratory failure, maybe they develop kidney failure while they're in the hospital... all of this is because they've gotten COVID-19," Arwady said. "If unfortunately, this person dies while they're in the hospital, the doctor has to fill out the death certificate, and you list the things that this person had, as well as what is the ultimate cause of death. And so if I was filling out the death certificate for this person, I would say this person had heart failure and diabetes and lung disease. I might include the kidney failure they developed in the hospital due to COVID-19 and that is me making an assessment that that virus itself was why that person died."
More important, the CDC figures show what medical professionals have been saying since the outset of the pandemic — that the virus tends to have a more severe impact on people with underlying conditions.
For example, people died with diabetes not because of it, said Dr. William Schaffner, an infectious-diseases expert at Vanderbilt University.
“If it hadn’t been for the COVID virus infection, these people would be living today," he said. “So yes, although they have contributing underlying chronic health factors, it’s still the COVID virus that killed them.”
It's not just the recent CDC report sparking questions on social media, however, Arwady said.
"So a corollary question I sometimes get is, 'What if somebody you know, gets shot and they die, and then you test them and you found out they had COVID-19?'" Arwady said. "Their cause of death is getting shot. It is not COVID-19. If they're getting tested, they could get counted as cases of COVID-19 but not as the death being caused by COVID-19. So there is a process where in reporting somebody's death, you include any of the things that may have contributed to their death. And you name an underlying cause that is the primary cause and the reports of people who die of COVID-19 or people who died because of being infected with with COVID. So I hope that sort of helped clears helps clear it up. I wish that we had only had 9,000 people die of COVID-19. But that is unfortunately not true."