Psychology 101 – Unintended Consequences?    -   December 5, 2020

When Comorbid Conditions Cause “Covid-19 Deaths” – Why is Covid Primary?

Sales people are paid commissions to increase sales, and managers are paid bonuses for maximizing profits.  That works because most people do what gets them the best return.  The same psychology sometimes causes unintended behaviors, perhaps with Covid-19 reporting.

Most people are not seriously affected by Covid-19.  Some are.  A tiny percentage get it and die.  Those who are seriously affected or die virtually always have underlying conditions that compromise their systems.

When someone dies, the death certificate records an immediate cause of death, along with up to three underlying conditions that “initiated the events resulting in death.”  The most prevalent “comorbid conditions” where Covid-19 was listed as primary cause of death are various respiratory diseases, circulatory diseases, malignant neoplasms, and alzheimer disease and dementia.  Deaths due to external causes (injuries, accidents, suicides, homicides, etc.), or indirectly related to Covid-19 (e.g., deaths occurring in the context of health care shortages or overburdened health care systems), or unknown causes are excluded from underlying conditions.

For around 95% of deaths where Covid-19 is reported on death certificates, it is designated as the primary cause of death.  Statistics resulting from that practice are likely distorted.  Consider:

Higher Covid-19 numbers get publicity and attract aid.  Massive amounts of federal and private dollars and material aid have gone to states and cities that pleaded for assistance because of reported or projected Covid-19 case loads.

Medicare pays extra for Covid-19.  The CARES Act provides for a 20% add-on to payments for Covid-19 inpatients for the duration of the public health emergency.  It also waives some regulations for Long-Term Care Hospitals and Inpatient Rehabilitation Facilities when dealing with Covid-19 patients.  It stands to reason that patients with even more-serious underlying conditions will be claimed as Covid-19 patients, and when such a patient subsequently dies, Covid-19 will be designated as primary cause of death.

Plausible acceptability probably leads some harried practitioners to list Covid-19 as cause of death without sufficient examination to unambiguously identify the primary cause.

Who knows how much such factors skew the statistics, or whether the picture they present is materially misleading, or whether wrong policy decisions are based on them?  Maybe no one.  But shouldn’t we be aware and beware of provisions and practices that incentivize inflation of corona-virus reporting?


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