Reason behind Dying: A Primer

Cause of Death: A Primer

Guest article by Kip Hansen – November 27, 2020

There has been massive media coverage of Covid-19 deaths – and there have been many. The CDC reported at 12:00 p.m. on November 26, 2020 that there had been a total of 259,005 Covid-19 deaths in the United States.

Anyone who reads a lot knows that a victim of a motorcycle accident has been reportedly reported as a Covid death. There are many who correctly report that all people who die from or with Covid and are even suspected of dying from or with Covid-19 are considered certified reportable headlines Covid-19 deaths.

(Note: This is a long and fairly detailed explanation of what leads to the situation we find ourselves in regarding coverage of Covid-19 deaths. If you want to understand the topic better, read on. With little or no interest, readers can simply accept this brief summary: "It's complicated" and on to other posts. )

Various experts, journalists, bloggers and experts report that it is "Covid Deaths" counted, counted incorrectly and even undercounted. Other experts and media-reported experts are desperately trying to reassure us that the number of Covid deaths is correct and real – and that we should all remain concerned and obey all government mandates – that range from "reasonable" to "obviously based on magical thinking." Bars and restaurants vary at 10 p.m. when the Corona Virus zombies attack – all despite the fact that different governments have different and conflicting mandates (or even have no mandates) and the different states in the United States have different rules and follow guidelines for Covid Deaths reporting. Those reporting "facts" such as "17 times overestimated US Covid-19 deaths" (based on this CDC comorbidity data) are sadly mistaken and misinforming the general public, which only adds to the general confusion in this area .

Doctors, coroners and medical examiners will calmly explain that "cause of death" is complicated and not easy. And they are right. Most of us think that if a person dies, it is obviously what killed him / her. But that's just not the case. In fact, everyone dies from a combination of "cardiac arrest" and "respiratory arrest," which eventually leads to "brain death." However, these are usually not listed as the cause of death on a death certificate.

Covid deaths are counted and reported on the recommendation of the CDC, which based its advice on advice from the Council of State and Territorial Epidemiologists (.pdf). Later more.

The primer: what is meant by cause of death?

When a person dies in a hospital or other setting, there is a doctor, coroner, or medical examiner to fill out a death certificate – officially certifying that John / Jane Doe died, including the date, time, location, social security number, and other information personal data along with the circumstances and the sequence of events that led to this death.

Here is a picture of the cause of death portion of a typical death certificate, annotated by the CDC:

We are only interested in parts I and II here.

"Part One.

This section of the death certificate indicates the sequence of conditions that directly resulted in death. The immediate cause of death, that is, the disease or condition that preceded death and is not necessarily the underlying cause of death (UCOD), should be reported on line a. The conditions that led to the immediate cause of death should be listed below in logical order in terms of time and etiology.

The UCOD, which is “(a) the illness or injury that triggered the train of pathological events that lead directly to death, or (b) the circumstances of the accident or violence that caused the fatal injury “(7), should be the lowest line used in Part I. "

(Source: CDC here – .pdf)

Let's look at a CDC example:

This patient had coronary artery disease for seven years – resulting in coronary artery thrombosis from which the patient suffered for 5 years – which resulted in acute myocardial infarction (heart attack) after which he survived for 6 days until – his heart broke and death led in minutes. Conditions that contributed to his death included diabetes, COPD, and smoking. Each of these “significant conditions contribute to deathThey are self-known to cause a variety of other serious conditions. For example, smoking is thought to cause COPD and heart disease. Diabetes can cause cardiovascular diseases, "including diseases of the coronary arteries with chest pain (angina pectoris), heart attack, stroke and narrowing of the arteries (atherosclerosis)". Note that there is a special section “35” that asks whether tobacco use contributed to death. The doctor chose “Yes” for this patient – therefore the CDC counts this death as one of the 480,000 tobacco deaths annually.

Let's look at another example (from the same document):

This person had non-insulin dependent diabetes mellitus, often referred to as type 2 diabetes. for 15 years. As sometimes happens, this diabetic eventually got into a hyperosmolar nonketotic coma, which she stayed in for 8 weeks, before finally succumbing to acute kidney failure (renal failure). The patient's family told friends and neighbors that their loved one died of kidney failure. You may have mentioned that this was likely the end result of his long-term diabetes. Type 2 diabetes is known to cause the following conditions: Heart and blood vessel diseases, nerve damage (neuropathy), kidney damage (as in this patient), eye damage, slow healing, hearing impairment, and even Alzheimer's.

It is clear that this second patient died of acute kidney failure – "Acute kidney failure is most common in people who are already in the hospital, especially seriously ill people in need of intensive care" – and is not necessarily a direct result of diabetes – but is believed In this case, kidney damage can be caused by diabetes. The order of Part I death certificates is appropriate and reflects the doctor's professional opinion.

“Confirming the cause of death should report any disease, abnormality, injury, or poisoning that is believed to have adversely affected the deceased. If alcohol and / or other substance use, a history of smoking, or a recent pregnancy, injury, or surgery are believed to have contributed to the death, the condition should be reported. The conditions prevailing at the time of death can be completely independent of one another and arise independently of one another. or they can be causally related, that is, one condition can lead to another, which in turn leads to a third condition, and so on. Death can also result from the combined effects of two or more conditions. "

Source CDC Medical Examiners & # 39; and Coroners & # 39; Handbook on Death Registration (.pdf)

In order to, you State the cause of death for these two patients. What was that Cause of death of each? Did Diabetes Kill Them Both? The first patient of atherosclerosis that triggered the sequence in Part I? The second coma caused by diabetes or was the coma simply caused by intensive care? Or was it the patient's first lifelong cigarette smoking that caused the coronary artery disease? Or would you, like this doctor, start the death sequence with his seven year old atherosclerotic coronary artery disease? In any case, there are several sequences that would be useful and could be entered correctly by the attending physician, forensic pathologist, or later by a medical examiner.

The above are pretty common examples – long-term conditions leading to the next condition that eventually leads to death. We don't see the personal information part of the death certificate, so we don't know it Age these patients. The age of the patient is often the key to the cause of death – but must not be used as the cause itself.

“Common death certificate problems

The elderly deceased should have a clear and unambiguous etiological sequence for cause of death, if possible. Terms such as senescence, infirmity, old age and advanced age have little public health or medical research value. The age is noted elsewhere on the certificate. If a series of conditions resulted in death, the doctor should choose the single sequence thatin his opinion, best describes the process that leads to deathand don't place any other relevant conditions in Part II. "(Source: CDC my bolds – kh)

And then this:

"For statistical and research purposes It is important that the causes of death, and especially the underlying cause of death, are given as precisely and accurately as possible. Careful reporting results in statistics for both underlying and multiple causes of death (i.e. all conditions stated on a death certificate) reflect the best medical opinion.

Each cause of death declaration is coded and tabulated in the statistical offices according to the latest revision of the International Classification of Diseases. "

Source CDC Medical Examiners & # 39; and Coroners & # 39; Handbook on Death Registration (.pdf) – my bold print – kh

There are over 69,000 ICD-10 diagnostic codes. Someone goes through each death certificate submitted and translates the diseases and conditions that the doctors, coroners, and medical examiners enter in Parts I and II into ICD-10 codes (soon to be ICD-11 codes). There are so many codes that there are many online lookup tools and apps that medical staff can use to encrypt office visits and other certificates of causes of death. The first death certificate mentioned above could be coded as follows: “E08.01 Diabetes mellitus due to an underlying disease with hyperosmolarity with coma” – which would cover Part I lines “c” and “b”. This diagnosis is billable. This app provides employees with helpful information when the ICD-10 code they have selected is "billable". If it's not billable, we can safely suspect that office assistants who encode office visits may be looking for a real but alternative diagnostic code that is billable. "All conditions mentioned on a death certificate" are translated into ICD-10 codes and then tabulated "for statistical and research purposes". In our two sample death certificates, ten different diseases and conditions are mentioned. Thus, each of the ten condition codes at CDC and WHO level receives a small "check mark" – a plus sign – that is added to the number of deaths to include this ICD-10 code.

As we see in this next quote from the CDC, the large number of reported deaths cited as being caused by smoking is:

“Smoking is the leading cause of preventable death. Tobacco use causes more than 7 million deaths each year worldwide. If smoking behavior around the world does not change, more than 8 million people will die each year from tobacco-related diseases by 2030.

Cigarette smoking is responsible for more than 480,000 deaths each year in the United States, including more than 41,000 deaths from second-hand smoke exposure. This is roughly one in five deaths a year, or 1,300 deaths a day. "

(Source: CDC here)

Most people simply accept these statements as fact, despite not knowing anyone who has put a cigarette in their mouth, lit and died as a direct result. Through many years of public health education on anti-smoking / anti-tobacco health, we have been taught that smoking or otherwise using tobacco can lead to a long list of health problems, many of which cause or contribute to the death of the smoker. In this case, a lifetime of tobacco use is referred to as a "cause of death" by public health officials – although it would likely not be listed as a cause on a death certificate. Although the CDC and WHO are not listed as a cause on the death certificate, they clearly tell us that smoking “is the leading Cause for avoidable death”.

As in many complicated subjects, different definitions are used for the same terms – in this case "cause of death". There is common everyday usage – like "something that directly causes a person's death, if it had not happened they would not have died". So a person will develop lung cancer, likely or suspected of having smoked for life, and die of lung cancer. We know they died of lung cancer, but we accept that smoking caused that death. This definition is used by the WHO above. But it is Not the official definition to be used on a death certificate as the cause of death, identified as Part I in the quote above.

Those readers who watch one of the popular television series about crime and police know that the cause of death is trauma death even more complicated – "Murder, accident or suicide?" – although these TV medical examiners are always portrayed as almost paranormal insights – "blunt trauma to the head … but that didn't kill him."

One final quote from the Medical Examiner's Guide:

“Precision of the knowledge required to fill out death certificates

The cause of death section in the medical examiner or coroner certification is always a medical one opinion. This opinion, of course, is a synthesis of all the information that emerges from an examination of the circumstances of death. It is the medical examiner or coroner's best effort to reduce his entire synthesis of the cause of death to a few words. "

(Emphasis in the original – kh)

Bottom Line: Determining and reporting the cause of death is complicated and relies heavily on the training and opinion of the person making the report.

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Reporting of Covid-19 deaths

Here is the linchpin for Covid-19 deaths:

This emerges from the CDC's weekly Covid report. See the heading column 2? It is called "All deaths with Covid-19 (U07.1) 1". The key word is PARTICIPATION. To be very clear, what the CDC reports, as collected by the National Center for Health Statistics, is all (all) deaths (people who die) Involved Covid-19. Do you see the little footnote indicator "1"?

In footnote 1 it says: "COVID-19 deaths are identified with a new one ICD – 10 Code. When COVID-19 is reported as a cause of death – or when it is listed as a "likely" or "suspected" cause – the death is coded as U07.1. This can include cases with or without laboratory confirmation. "

Not just verified cases where Covid-19 was the immediate cause of death. At least, to be more clear, not necessarily what you, the average reader, would consider THE Cause of death.

So what exactly are they counting when the CDC and WHO report Covid-10 deaths? The official guidelines of the World Health Organization are:


Death due to COVID-19 is defined as death due to for surveillance purposes a clinically acceptable disease, in one likely or confirmed COVID-19 case, unless it's clear alternative cause of death that cannot be linked to COVID disease (e.g. trauma). ….


COVID-19 should be noted on the medical certificate stating the cause of death ALL deceased where the disease caused, or is believed to have caused or contributed to death.

(my focus – kh source: WHO here .pdf)

Note that the Death Certificate – Cause of Death Part II are "Other Important Conditions That Contribute to …". There Covid-19 (ICD code U07.1) would be written for every death in which Covid was not "caused, or is probably caused " but only contributed to death. If the deceased was a "Covid case", he / she becomes a "Covid death" when he / she dies. Continue reading . . .

For the general public who would like to know how many people are killed by the SARS-CoV-2 pandemic, this definition does not provide an answer to their question. The vagueness and breadth of these definitions are exacerbated in this “possibly too broad” sense by the definitions used to define “what is a Covid-19 case?”. We see that the WHO definition of a Covid death “includes a probable or confirmed COVID-19 Case".

How do WHO and CDC define or advise physicians on definition / determination? a Covid-19 case?

Clinical Criteria

At least two of the following symptoms: fever (measured or subjective), chills, rigidity, myalgia, headache, sore throat, new odor and taste disorder (s)


One or more of the following symptoms: cough, breathlessness, or difficulty breathing


Severe respiratory illness with at least one of the following conditions:

Clinical or radiological evidence of pneumonia, OR

Acute Respiratory Distress Syndrome (ARDS).


No alternative, more likely diagnosis

(Source: CDC here)

According to this definition, I could be declared a Covid-19 case at this moment. I have muscle pain (myalgia) and headache – two symptoms – and I had a cough yesterday – and when I reported to the emergency room and the doctors are rushed and frightened by the pandemic, there may be "no more alternative likely diagnosis", at least in her mind. (Of course I have these symptoms for reasons known to me and my personal doctor, but this might not save me in the emergency room.) Especially if they ask me a few too epidemiological issues::

“Epidemiological Link

One or more of the following exposures in the 14 days prior to the onset of symptoms:

Close contact ** with a confirmed or probable case of COVID-19 disease;


Close contact ** with a person with:

clinically acceptable disease


Link to a confirmed case of COVID-19 disease.

Are you traveling to an area or living in an area where SARS-CoV-2 is sustainably transmitted by the community.

Member of a risk cohort as defined by health authorities during an outbreak.

** Close contact is defined as being within 6 feet for a period of at least 10 minutes to 30 minutes or more, depending on the exposure. In healthcare, this can be defined as exposure for more than a few minutes or more. The data are not sufficient to precisely define the duration of exposure, which represents longer exposure and thus close contact. "

(Source: see previous quote)

So if I were in the emergency room, the emergency doctor might ask me these questions: Do you know someone who is not doing well? Have you been in close contact with them for more than 10 minutes? Have you attended a meeting with more than 10 people in the past 14 days? Have you been to church or a party? Have you visited a restaurant or a bar? Every YES qualifies me epidemiologically as a Covid case. Other questions: Do you wear a face mask when you are not home? in your car in WalMart? in the park? while mountain biking? Every NO epidemiologically qualifies me as a Covid case.

You can see how easy it is to get classified as Covid-19 case. And they haven't even tested me yet. (Read the link to see why even testing wouldn't save me.) You would report me as a Covid case even if I had tested negative – I couldn't be positive "yet".

And while I'm jokingly describing my upcoming Covid-19 case classification, it is a very real scenario. And if I died of almost anything (except an obvious trauma) in the next 14 days, I would become another Covid-19 death stat.

As most of us know by now advanced age a key factor in the vast majority of deaths from Covid-19 is:

Eighty percent (80%) from Covid-19 are deaths from it 65 years or older – and a full one one third of the deaths occur in these over 85 years. If you are an adult today, you were born between 1925 and 2000. When you are born, you can expect a life (life expectancy at birth) between 58 and 72 years, depending on the year of birth. Those who die at age 85 or older had a life expectancy at birth of less than 61 years. (My life expectancy at birth was approximately 66 years – so I've exceeded the odds and hope to do so for many years to come.)

If this doesn't seem important to you, I'll repeat the CDC quote on reporting the cause of death for the elderly – people aged 65 and over.

"Common problems with the death certificate: The elderly deceased should have a clear and unambiguous etiological sequence for cause of death, if possible. Terms such as senescence, infirmity, old age and advanced age have little public health or medical research value. The age is noted elsewhere on the certificate. If a series of conditions resulted in death, the doctor should choose the single sequence thatin his opinion, best describes the process that leads to deathand don't place any other relevant conditions in Part II. "(Source: CDC my bolds – kh)

For the elderly, the elderly, and the elderly, who make up the majority (80%) of Covid-19 deaths, any disease or condition that causes respiratory problems can be classified as a Covid case, and therefore a Covid-19 death in "a clinically acceptable disease, in one likely or confirmed COVID-19 Case".


  • It's complicated.
  • Make no mistake, there are many people dying from deaths that have been confirmed, suspected, or suspected of having Covid-19.
  • Somewhere between "most" and "almost all" of these deaths, there were other conditions involved that were already killing the patient – sometimes slowly, sometimes quickly.
  • The official health organizations have their own reasons for what they count as well They count exactly what they say they count – but it's not what you or I would expect them to count. They count, like the CDC, "All deaths from Covid-19".
  • The Covid-19 death statistic reflects the number of WHO, CDC and other national and state health authorities. The general public often mistakenly believe that these counts mean deaths of which Covid-19 was the one immediate cause of death – Deaths in which the person was killed by Covid-19. That's not the case – it's far more complicated.
  • The citizen would have serious doubts about inclusion every single one of these dead in the count of deaths caused by Covid-19 when charged with verifying all the details of each death. Our citizen could come up with our own reasonable classifications: "Age complicated by pneumonia caused by a viral respiratory infection: possibly Covid-19 or influenza or the common cold".
  • Doctors (and here), coroners, and medical examiners are not immune to simple abbreviations. The official definitions for Covid-19 cases (in essay) make it an easy choice for doctors in a hurry and official guidance requires at least the mention of Covid-19 on death certificates under a variety of normal circumstances during this pandemic. This is exacerbated by RT-PCR tests, which give "positive" test results for very small amounts of viral RNA fragments in asymptomatic individuals.

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A trap has broken out regarding Genevieve Briand's research at John Hopkins on U.S. Covid-19 deaths: I provide these links to the controversy:

Covid-19 Deaths: A Look At US Data

PDF file:

William Briggs:

Twitter thread on paper:


WayBack: 19th

Cancellation policy for the John Hopkins newsletter:

Author's comment:

I mentioned earlier that I came from a medical family and studied the requirements for a medical degree at university before switching majors for personal reasons. Our home was filled with the joys of new life and the sadness of the death of babies and children. My generation fought and died in the thousands in the misguided military intervention in Vietnam – some of them my high school and college cousins ​​and friends.

We are all sad when life is cut short.

Covid-19, the disease caused by the SARS-CoV-2 virus, is shortening the lives of thousands in the US and around the world. A blessing is that it mainly shortens the lives of those who have already had a life – as opposed to stealing the entire lives of our children and teenagers.

Public health organizations have valid reasons to count "All deaths from Covid-19" using their own internal definitions suitable for epidemiological study and research when combined with any other information gathered to compile these statistics. This statistic, compiled with their surveillance and epidemiological definitions, is not suitable for publication to the general public without a long and complicated explanation – just release the number and mark it as Covid-19 deaths is a form of misinformation.

The media, politicians, health officials and governments have completely failed to effectively communicate the reality of deaths in Covid, fail to shed light on the reservations and complexities of reporting causes of death, and instead repeatedly report this "large number" in only one specific use seems to be deliberately misleading.

Opinions on this issue are different.

Please direct your comments to "Kip …" when you speak to me.

Thank you for reading.

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