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?

Comments

February 1, 2021 David B. - Pennsylvania:
Your blog (re Covid-19 reporting) is perfect. I totally agree with your explanation. Too much of what is reported in the media and Big Tech is very biased in favor of the Liberal Left. Thanks for your insightful analysis.
December 20, 2020 Kurt K. - California:
To imply that frontline medical workers are misrepresenting cause of death in order to gain more cash from Medicare is to impugn the hard work & integrity of countless people putting their lives on the line to fight a deadly virus. If someone with a heart condition struggling to gather in their last breaths because of COVID-19 ends up having a heart attack, it is accurate to assess the actual CAUSE of death is the virus that left that person struggling & triggered a heart attack. To claim the cause of death is the heart condition is to ignore the condition that determined the actual moment of that person’s death.
December 9, 2020 Tommy D. - Texas:
Great Information!
December 5, 2020 Tommy D. - Texas:
It is hoped that you are not involved in spreading Chinese based lies about the Corona Virus. In late January my American Chinese students were talking about the suppression of Covid by the Chinese government. I find it intriguing that the White Hate Groups in America as well as the President, have also been actively stating that Corona is a hoax. I remember looking at some of the Alex Jones type posts which are full of "digital alterations", showing a couple of vids on the idea that hospitals in "other" countries were empty. They showed what appeared to be an empty parking garage in Paris, during the day. Later they posted another video of the same hospital at night claiming that this was in Melbourne Australia. You have to have a good memory to detect lies like this. The fact is that millions of people have died recently and that isn't normal by any stretch of the imagination.