As a pathologist who certifies deaths I understand why: Excess deaths capture deaths from Covid + all the deaths that are Covid-related. e.g. If you get myocarditis from Covid but die of heart failure months or years earlier than you should, we wouldn’t know it was from Covid.
I would just do an autopsy and sign it out as “probable cardiac arrhythmia due to myocardial intertstitial fibrosis” or maybe blame your concomitant atherosclerosis. The way Covid19 attacks endothelial cells, it causes long term damage in the heart and brain.
These two organs don’t do well long term with vascular damage. Brains develop strokes, aneurysms & hearts develop arrhythmias. I would not be surprised if Covid survivors have shortened lifespans from diseases like strokes, aneurysms or heart disease.
These organs also kill you suddenly & unexpectedly which means this will put more burden on our already understaffed sudden death investigation systems. You think we don’t have enough nurses & ICU docs, wait till you find out how few forensic pathologists there are.
But most of these deaths won’t even get autopsies. They will be written off as “natural” deaths due to heart disease and we won’t figure out that they were the long term effects of Covid19 until years later… when we look at the excess deaths in an entire generation.
Which is why I have, from the start of this pandemic, advocated for caution in approaching any pathogen we don’t know that much about. All the voices advocating for “reopening” because of economic or social collapse were not considering the long term effects.
Even now, @CDCgov guidelines of shortened isolation, PPE use & home testing appear influenced by social/economic demands for staffing and not on best public health practices.
Home testing, for instance, is not public health. It’s private health. In the US the testing burden shifts to you, the consumer, and this we lose important data in our public health system on actual numbers of new cases. Poor people can’t afford these tests.
Nearly two years into this pandemic and the U.S. still has no mask mandates, no way to get everyone free N95s, which is what we know works. Masks are cheaper & easier than lockdowns, than anti viral drugs. Contact tracing has been abandoned. Again, burden put on the individual.
If you get sick the burden is on you to figure out and tell who you may have exposed. This isn’t public health. This is a complete abrogation of responsibility & a public health system that has given up.
The U.S. will continue to fuel the fires of Covid19. The next challenge may be a variant that evades rapid tests & vaccines. I ask again, how many people need to die before they figure out that the open secret to handling this pandemic better is already being implemented?
Look to China, Taiwan, S Korea, New Zealand. Learn from what they already know: 😷 works , vaccines work, public health campaigns with good science communicators work, managed isolation & limits on freedom of travel/movement work. They don’t have to be draconian.
You can find a formula that works for your political system, but by all means *use them.* People trust government when it shows results. Public health is the cornerstone of good government and long term economic prosperity. /End rant.

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More from @drjudymelinek

20 Feb 21
Cognitive Bias in Forensic Pathology Decisions was published today by Journal of Forensic Sciences…
From the abstract “We examined all death certificates issued during a 10-year period in the State of Nevada in the United States for children under the age of six.” /2
We also conducted an experiment with 133 forensic pathologists in which we tested whether knowledge of irrelevant non-medical information that should have no bearing on fo- rensic pathologists’ decisions influenced their manner of death determinations. /3
Read 11 tweets
6 Feb 21
Marijuana and death. A thread👇🏻
As a forensic pathologist it is my job to certify death in cases of drug intoxication. I can’t think of a single case in my 20 year career where THC (the active ingredient in weed) was ever the cause of death on its own. /1
THC may be present in combination with other drugs such as synthetic cannabinoids, alcohol, or methamphetamine in mixed drug intoxication deaths. In those cases we may list THC on the death certificate (DC) with the other drugs. This is to acknowledge its presence /2
NOT to imply that it would have killed the decedent on its own. In illegal drug markets it’s may not be unusual for THC to be tainted with “spice” “K2” (synthetic drugs) or fentanyl derivatives to increase the “high.” These additives are more likely to kill the user. /3
Read 8 tweets
30 Jan 21
In response to @nytdavidbrooks
A thread. 👇🏻
You can’t argue studies & reports with fear. Minority communities have been disproportionately affected by their families dying. The unions are representing the teachers who are also POC, at risk & don’t want to die.
I see both sides of this issue and it’s only a problem because of a lack of a Federal response and Federal leadership. If the US had a functional @CDC last year and had set out guidelines for school reopening we wouldn’t be here.
I quit my job because the protocols I wrote weren’t being followed so I don’t blame unions one bit for advocating for the health & safety of their workers.
Read 10 tweets
7 Jul 20
So we just landed in New Zealand. Temperature checks and symptoms screening on landing. Now taken on a bus to a quarantine hotel for two weeks in Auckland. This is how you properly manage a border in the age of #COVID19 Image
We are staying at the Sudima hotel. This was breakfast the first day. Little adorable meat pies and porridge. The meat pies were good. I chomped one before thinking to take the photo. Image
This is the booklet we got when we checked in. Published by the New Zealand Government @ChiefSciAdvisor It’s 20 pages long. It covers all the questions you might have about quarantine including what might happen if you test #Covid19 positive. Image
Read 25 tweets
30 May 20
So what does "no physical findings that support a diagnosis of traumatic asphyxia or strangulation" mean?… #GeorgeFloyd - a thread /1
Without seeing the actual autopsy report or autopsy photos it’s hard to tell based on that phrase alone. Generally it means that there’s no trauma to the front strap muscles of the neck, hyoid bone, thyroid or laryngeal fractures. /2
But a broad, even force on the side of the neck wouldn’t necessarily leave much of a mark on the strap muscles of the front of the neck the way a hand would in manual strangulation. /3
Read 10 tweets
6 Jan 20
Thread. Jeffrey Epstein photos are out and here’s my take:… 1
Disclaimer: I wasn’t consulted by the press & don’t have access to all the photos, just the ones in the news reports. The quality is not as good as if I had originals digital files. 2
That said, in the photos shown the ligature furrow appears horizontal and does not appear to elevate behind the ears. There is also injury to the right back base of the neck. This is concerning for a strangulation rather than a hanging. 3
Read 9 tweets

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