🧵We are unquestionably, undeniably, per policy counting deaths WITH Covid and not from it, and have been doing so the entire time. I will lay out evidence demonstrating that this is not a matter of opinion or subjective interpretation, this is 100% objective reality... 1/x
In early 2020 a group from an association of epidemiologists (CSTE) proposed a case definition for SARS-CoV2 which would establish the criteria by which someone could be identified (or ruled out) and reported as a Covid case... 2/x cdn.ymaws.com/www.cste.org/r…
It was adopted almost in full by the CDC, officially published April 5 2020 and updated twice since then. Most of the report concerns "probable cases," or how to report someone as positive without a lab test to confirm... 3/x ndc.services.cdc.gov/conditions/cor…
"Confirmed cases" were less complicated: simply testing positive by PCR. However its simplicity also meant that all positive PCR tests were confirmed cases, regardless of symptoms or any illness in the patient... 4/x
It also means if any of those "confirmed cases" died, they fell into the category of "confirmed death."
We'll see that this is inferred policy. The only part of the CDC's guidelines that mentions death deals with "probable death" without a history of testing... 5/x
Since Trump left it up to each state to come up with their own policies, each state and sometimes individual counties came up with details how to comply with the CDC's guidelines for reporting... 6/x
Most states crafted policies using the exact language of the CDC. However, confirmed deaths weren't clarified by the CDC.
If a confirmed case is in relation to a positive PCR test, how much time can pass before somebody's death for them to qualify as "confirmed death"?... 7/x
This was determined by public health. For example, Florida's public health essentially copy-pasted the CDC's definition and has not specified an interval of time between testing and death to qualify or not qualify as Covid death... 8/x floridahealth.gov/diseases-and-c…
Some states, like NJ here, haven't even copy-pasted the CDC's verbiage. They simply put a link to the CSTE definition adopted by the CDC, which again states that a confirmed case/death is a positive test, nothing more... 9/x covid19.nj.gov
Most places that I've found who report their Covid data are like this, either linking to or reprinting what the CDC has stipulated. But some states have gone a little further with their case definitions and reporting requirements... 10/x
NYC Health Dept for example has stated that a "Confirmed death" is any death within 60 days of a positive PCR. Thus "confirmed" does not refer to having confirmed a cause of death, just a prior positive test... 11/x www1.nyc.gov/site/doh/covid…
Now, my own state of Oregon's policy is similar but with a twist. Here a Covid death (officially "Covid-19-related death") is a death within 60 days of a positive test, or 60 days of onset of symptoms in the absence of a test (probable case)... 12/x oregon.gov/oha/PH/DISEASE…
here's the twist: all hospitalized cases who die 60 days AFTER discharge FOR ANY REASON is a Covid death. Bonus twist: anybody who tests positive up to 2 weeks prior to hospitalization or anytime during is a "Covid hospitalization," no matter reason for admission... 13/x
In LA County, where last I checked there were 5 times as many "Covid deaths" as the next deadliest county, Providers are required to report the death of any person within 90 days of a positive PCR test. Again, there is no relation to cause of death... 14/x publichealth.lacounty.gov/acd/ncorona201…
And then there's Colorado. CO Public Health's FAQ page states explicitly that they count deaths with Covid.
They ask themselves: Why count deaths with Covid if CoV didn't cause it? --Because all states do it, it's how the CDC wants it reported... 15/x
This ties in also with the way deaths are often described across media and government reports.
Covid-19 associated deaths
Covid-19 related deaths
Deaths connected to Covid-19
In their weekly provisional death count, the CDC officially counts "deaths involving Covid-19"... 16/x
** completely as an aside, in case anyone's wondering why the same "deaths involving" language is used about flu & pneumonia in the previous CDC graphic, I haven't done much research into it, but here's some insight into flu data gathering... 17/x post-gazette.com/news/health/20…
Very early on some leaders were asked to account for these guidelines, or at the very least clarify them. Under Trump, Dr. Birx was chief physician of the WH Coronavirus Task Force. She clarified the CDC's guidelines... 18/x
Some may have seen Dr. Ngozi Ezike, director of Illinois Public Health, explain how the state of Illinois was gathering its data
"...Covid death doesn't mean that that was the cause of death, but that they had Covid at the time of death" ... 19/x
One of the most interesting and revealing statements from a public health official about Covid statistical gathering came from Connecticut.
On April 1, 2020 CT Governor Ned Lamont had some sad news and a strong warning to share with everyone... 20/x
The baby was asymptomatic but tested positive on autopsy. The medical examiner refused to sign off that Covid was the cause of death.
Two days later, Lamont passed off a question about the baby to state epidemiologist Dr. Matthew Cartter... 21/x
Fast forward to July 2020, the medical examiner made his final ruling in the case. Although the baby did not die of Covid, the baby's death still fit Dr. Cartter's description of a Covid-related death ie related to a test, not cause of death... 22/x
Not everybody got the memo from Dr. Cartter though. In May 2020, first came reports of CO Public Health "reclassifying" non Covid deaths in nursing homes as Covid, then a CO man who died of alcohol poisoning in a park was added to the list... 23/x denver.cbslocal.com/2020/05/14/cor…
The equation used by public health, literally described in their statement to CBS4 is
positive PCR + (and then died) = Covid death
And the 'about the data' section they refer readers to is where I pulled the FAQ section "why do we count deaths with Covid?"
Some medical examiners in Michigan were similarly puzzled
"I think a lot of clinicians are putting that condition (COVID-19) on death certificates when it might not be accurate because they died with coronavirus and not of coronavirus."
But sometimes the medical examiners in MI knew what the expectations were from early on... 26/x
Several weeks after the press briefing w/Dr. Ezike (#19), she was in a Zoom meeting where she clarified her earlier clarification
"where the Covid infection had nothing to do with their deaths, we are at IDPH trying to remove those obvious cases..."
🤔okay, fair enough.
Only there's no way to tell which states are, and which are not reporting "obvious cases". But we do know for a fact that some states are reporting obvious non-Covid deaths as Covid deaths, and the CDC proved it beyond any question in December 2020... 28/x
Earlier I mentioned the CDC's weekly provisional death count, updated every Wednesday. There's a section that deals with comorbidities appearing on death certificates of Covid-related deaths... 29/x
notice on that comorbidity page how pneumonia is associated with fewer than half the deaths credited to a respiratory virus. Also on the list were ~90k alz/dementia patients, for whom pneumonia is the #1 cause of death... 30/x
In Dec 2020 the CDC published an expanded comorbidity report for weeks ending 2/1/2020 - 12/5/2020. They listed every single condition from the 255,508 death certificates of individuals reported to Public Health as Covid deaths at that time... 31/x cdc.gov/nchs/data/heal…
All the people with cancer, renal failure, cardiovascular disease, neurovascular disease - you can read about them in the weekly update.
The December report showed, for example, how many people had foreign objects in their respiratory tract (also known as choking)... 32/x
which proves nothing one way or another.
Neither does this sampling of drug overdoses among those people whose deaths are associated with Covid-19... 33/x
People experiencing organ transplant failure and rejection are a harder sell for me that Covid is at fault... 34/x
Here are the accidents that 5 months earlier Dr. Ezike said IDPH was removing from the tally. Car accidents, motorcycle accidents, heavy truck and bus accidents, both pedestrians and drivers. Each get their own ICD-10 code... 35/x
A fair number of people fell from a fair number of objects.
And I don't know which sounds worse - contact with a powered lawnmower or foreign body entering through eye or natural orifice... 36/x
Now all joking aside, I challenge somebody to explain to me the role Covid played in these people's drownings... 37/x
If somebody told you that included among Covid deaths you'll find people who committed suicide...
They told you the truth!... 38/x
Would you think I'm crazy if I said there's an unambiguous homicide on the list of Covid deaths?
What if I said it was a terrorist chemical weapon attack?
How would you respond?
When you start to dig deeper into media case reports, details emerge that make the picture clearer. Take for example when MI public health announced the death of a 2-month-old from COVID-19 to illustrate the danger to young ppl (just like in CT)... 40/x cbsnews.com/news/covid-dea…
You would have to stitch together from multiple sources that the baby was born with intestines outside of his body, had extensive surgery, perforated bowel + infection, necrotizing enterocolitis, aspirated on his vomit, died
had "GI symptoms of Covid"
Mom took to FB... 41/x
Nothing I've shown here should be over anybody's head. Everything is relatively simple to understand.
I want to quickly cover death certificate attribution, and I promise this will be just as easy to follow as everything else... 42/x
The "Cause of Death" section of a death certificate has two parts: Parts I & II
source: Cause of Death & the Death Certificate, College of American Pathologists... 43/x health.state.mn.us/people/vitalre…
Part I is what caused the death.
The top line is the immediate cause of death.
The bottom line would be the older underlying cause of death.
Older, underlying cause of death: hypertension
Immediate cause of death: stroke caused by hypertension
Part II of the "Cause of Death Section" is for other conditions present at the time of death.
These conditions are believed to complicate treatment and perhaps worsen the patient's condition, but do not cause the series of events which lead to death in Part I... 45/x
To show how this works
underlying cause of death (COD): alcoholism
intermediate COD: liver cirrhosis
immediate COD: brain damage from liver dysfunction
Pneu & GI bleed made matters worse, but the patient would still have died from brain damage anyway... 46/x
So Part I: older conditions directly leading to immediate cause of death
Part II: conditions present at time of death that complicate treatment, contribute to death, but do NOT cause the sequence of events that lead to the immediate cause of death
Got it? Good... 47/x
If we revisit the CDC case definition (and most states' definitions) we see that a Probable Death is any one in which Covid appears on the death certificate, Part I or Part II (ie "condition contributing to death")... 48/x
But we JUST learned that conditions in Part II don't initiate the underlying cause of death, and however significant they are, are not regarded as the immediate cause of death.
It can't be understood that a patient would be alive if not for conditions in Part II... 49/x
To be clear, the standards which the CDC requires violate the WHO's International Guidelines for Coding of Covid-19 as a Cause of Death.
Covid appearing in Part II is "NOT COVID-19 DEATH" even in relation to heart attack deaths, abundant in US Covid death statistics... 50/x
In fact, according to WHO's international guidelines, only death certificates listing confirmed or suspected Covid as the underlying cause of death are acceptable... 51/x
But again we (state PH + CDC) are not compiling a list of deaths attributing Covid as a cause of death, so WHO guidelines don't apply.
Listen again to Dr. Cartter (#21) We are compiling a list of Covid positive cases with a public health surveillance objective in mind... 52/x
Some questions naturally come up from all of this.
If the evidence is clear that we are not keeping a list of people whose deaths are directly attributable to Covid, why are media and politicians blatantly mischaracterizing it as such? Why are PH depts silent?... 53/x
Given what you've seen about "Covid deaths"
Will it surprise you to learn that Covid hospitalizations have nothing to do with a reason for hospital admission or the concern being treated?
Positive PCR during hosp stay or 2 wks prior to admission... 54/x cdc.gov/coronavirus/20…
It is undeniable that cases, deaths and hospitalizations get most consideration when justifying our Covid policies.
We've discussed deaths and hospitalizations.
We won't get into cases, but for now suffice to say there are reasonable objections to testing protocols... 55/x
Know that I'm not saying that people don't die of Covid.
Certainly people do.
But if you're going to make a claim to how many people that might be, be prepared to account for tweets 1-54 in your argument.
If you care to state how dangerous Covid might be, show your work... 56/x
If you feel I've reached the wrong conclusions please reach out (though honestly your beef is with public health at this point)
Know that I'll need as much counter evidence with original sources as I've offered to even get on the fence about this... 57/x
Britons you're welcome to join the conversation
this affects you too.
Is your Covid death policy common knowledge in the UK?
Canadians, join the discussion.
Did you know in your country a confirmed Covid death is defined in relation to a positive PCR test and not a cause of death?
At least it is in Ontario. Look up your province's case definition, let us know... 59/59 thanks🙏 health.gov.on.ca/en/pro/program…