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Does Anyone Really Know the Number of COVID-19 Deaths?

In order to measure anything you need a standard. One of the problems in counting the number of COVID-19 deaths is the standard varies. Different countries, different states, different hospitals and even different doctors are using different criteria—in many cases their best judgment—to determine a COVID-19 death.
That variation may be unavoidable, given the lack of available coronavirus tests and some hospitals’ crush of patients.
But major public policy initiatives—including trillions of taxpayer dollars—depend on having an accurate assessment of how many people actually die from the disease.
And here’s an added complication: The government pays hospitals 20 percent more than traditional Medicare rates for a Medicare patient with COVID-19.
Take a look at the Centers for Disease Control and Prevention’s “Provisional Death Counts for Coronavirus Disease.” As of May 4, the CDC lists 38,576 deaths—about half the number we see being reported in the media. The CDC also lists 17,122 “deaths with pneumonia and COVID-19,” and 66,094 pneumonia deaths.
Now, the CDC is very clear that these numbers are “provisional.” The agency says it can take several weeks for some death certificates to be submitted, processed and tabulated, which raises a question about how accurate our current information is.
In many cases doctors just have to use their best judgment in determining the cause of death. The CDC’s reporting guidance says: “In cases where a definite diagnosis of COVID–19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID–19 on a death certificate as ‘probable’ or ‘presumed.’ In these instances, certifiers should use their best clinical judgment in determining if a COVID–19 infection was likely.”
The director of the Illinois Department of Public Health, Dr. Ngozi Ezike, takes, shall we say, a “big tent” approach. She explained that in her state, anyone who dies with COVID-19 will be listed as a coronavirus death, even if the person was in hospice and COVID-19 played little or no role in the immediate cause of death.
And then there are the two emergency room doctors who recently expressed their concerns about some practices. Dr. Dan Erikson said, “We’re being pressured in-house [i.e., hospital administration] to add Covid to the diagnostic list when we think it has nothing to do with the actual cause of death.” looked into the issue of the higher COVID-19 reimbursement rates in April. It agreed that the federal government is paying hospitals more for COVID-19 Medicare patients, but did not conclude there was evidence that the higher rate was encouraging fraud. And there may be no fraud.
On the other hand, the federal government has long complained that states and hospitals engaged in questionable practices in order to maximize federal Medicaid payments to the states. So it is a concern.
Congress is making big—not to mention costly—decisions based on how deadly the coronavirus epidemic is. We know it’s deadly. But given flexible and shifting standards, it’s not entirely clear how deadly.