Continuing to return to this distinction is disingenuous and suggests bad faith. I have not seen a single case of a death pronouncement for COVID which has not unambiguously been from COVID. I'm not saying that shenanigans have never happened anywhere in this regard, but I'd guess that I've seen more people die OF COVID than any other single cause over the last few years, so it's hard for me to imagine that a handful of fraudulent cases would move the needle much.
> Were these people in long-term inpatient care / skilled nursing facilities? Or dependent on home health care aides and visiting nurses?
No, none of them. We don't have any of those nearby in my rural location.
> Are you claiming to have personally provided care to large numbers of previously healthy twenty-somethings and thirty-somethings who unambiguously died of covid?
You'd have to define large and "previously healthy." I'd speculate that the dozen or so deaths that I've seen in this category are "plenty" -- more than I've seen in this age group from any other cause in my short career, other than perhaps alcoholism.
I also really don't understand why this is so difficult for people on HN to believe. HN is an interesting place for technical topics, but the threads on medicine truly make me shudder. My one are is subject matter expertise is the one most likely to earn downvotes for some reason.
¯\_(ツ)_/¯
How about this one? https://wpde.com/news/nation-world/man-who-died-in-motorcycl...
Do you think that news report "moves the needle?"
Did you read this part in the article you posted? "it is unclear whether or not his death was removed from the overall count in the state."
Do you think that patients' right to privacy may make it difficult to know the details surrounding a death, leading to widespread, unfalsifiable, conspiratorial speculation?
Just because you've never seen something happen firsthand doesn't mean that it never happens, or even that it's particularly rare. For example, none of my computers have ever gotten ransomware, but I don't deny that ransomware is really common today.
> Do you think that news report "moves the needle?"
This feels like asking why you should bother voting, since one vote never really moves the needle by itself either.
> Did you read this part in the article you posted? "it is unclear whether or not his death was removed from the overall count in the state."
Yes, and it makes my point even stronger. Even for the most egregious, indefensible false COVID deaths like this one, we can't confirmation that they've actually been corrected. That leads me to think there's no hope whatsoever that any of the false ones that aren't this blatantly obvious will ever be corrected.
> Do you think that patients' right to privacy may make it difficult to know the details surrounding a death, leading to widespread, unfalsifiable, conspiratorial speculation?
If we can't get details of the death, why should we default to the assumption that it really was because of COVID?
So are you arguing that, because I've never seen it, then it must be common?
> I don't deny that ransomware is really common today.
You'll need to be more precise for this to mean much of anything. I don't know a single person who has ever had a single personal computer affected by ransomware. Clearly ransomware must be a governmental conspiracy and/or the common flu.
> This feels like asking why you should bother voting
It wasn't intended to feel like that. It was intended to feel like asking whether you think one news report -- or even several individual news reports -- are meaningful evidence of widespread fraud in the setting of a very large denominator of deaths.
> Yes, and it makes my point even stronger.
No, it doesn't. It means your point may not be a point at all, and it seems like you have no evidence behind your speculation that this was ultimately counted as a COVID death.
> If we can't get details of the death, why should we default to the assumption that it really was because of COVID?
Do you really think that the details of an individual patient's medical record should be opened up to try (likely in vain) to satisfy the curiosity of some dude on HN -- who is likely so entrenched in his or her position that the results of the inquisition will be of little consequence regardless?
If you are claiming to have seen "plenty" of previously healthy 20-somethings and 30-somethings who've died of (and not with) covid and "plenty" means more than one or two of each group since Feb 2020 and you're not jet-setting back and forth across the country to attend specifically to exceedingly rare young previously-healthy patients seriously ill from covid in widely-separated locations whenever they pop up, I'm sorry but I don't believe you.
¯\_(ツ)_/¯
No. I'm saying that it's not necessarily rare just because you've never seen it.
> You'll need to be more precise for this to mean much of anything. I don't know a single person who has ever had a single personal computer affected by ransomware. Clearly ransomware must be a governmental conspiracy and/or the common flu.
You're making my point for me. I acknowledge ransomware is a real problem even though I've never personally been exposed to it. I'm saying you should acknowledge that incorrect COVID death labeling is a real problem even though you've never personally been exposed to it.
> It was intended to feel like asking whether you think one news report -- or even several individual news reports -- are meaningful evidence of widespread fraud in the setting of a very large denominator of deaths.
But the whole point is that the "very large denominator" is inflated and untrustworthy.
> It means your point may not be a point at all, and it seems like you have no evidence behind your speculation that this was ultimately counted as a COVID death.
We have solid evidence that it was originally counted as a COVID death. People then looked for evidence that it was ever corrected but failed to find any. How is that "no evidence behind [my] speculation"?
> Do you really think that the details of an individual patient's medical record should be opened up to try (likely in vain) to satisfy the curiosity of some dude on HN -- who is likely so entrenched in his or her position that the results of the inquisition will be of little consequence regardless?
Are you saying I should just blindly trust that all of the ones we don't have information on are correct? That seems like it'd be a stretch even if we didn't have any evidence that any were ever misclassified.
I live and provide emergency care in rural place that several times was reported to have the worst rates and case fatality rates in the country. Virtually every patient I see and community member I know had at least one first-degree family member die OF COVID, and many more if you include cousins / aunts / uncles.
In contrast, my parents and family live in a place not far away that had something like 5% of the case-fatality rate we experienced here. I don't think my parents know a single person who personally died of COVID, whereas I had 6? or so coworkers (not other physicians -- several hospital housekeepers sadly) pass away.
I can see quite clearly why there is so much controversy about this disease (or at least one of the reasons) -- because it's just affected different populations very differently.
We act as if each other is talking about an entirely different disease, and we may as well be.
> I'm sorry but I don't believe you.
Then I suppose it's not worth having further conversation. Best of luck to you.
> I'm saying that it's not necessarily rare just because you've never seen it.
Agreed. Though my prior is that physician-committed fraud on death certificates is probably rare in general (having seen many deaths and gone through the process myself many times), and that my personal experience also confirms that it seems rare (with respect to COVID), so hopefully you can see why an analogy to a very unrelated topic doesn't feel like particularly convincing evidence.
> You're making my point for me. I acknowledge ransomware is a real problem even though I've never personally been exposed to it. I'm saying you should acknowledge that incorrect COVID death labeling is a real problem even though you've never personally been exposed to it.
No, I don't think I'm making your point, I think you're moving the goalposts. Your words were "really common," which is what I pushed back on. I didn't say anything about whether or not it's a problem (for either case).
> But the whole point is that the "very large denominator" is inflated and untrustworthy.
Again, it would be interested to get your guesses at what kind of numbers we're talking about, it's hard to know how much we're disagreeing here. The CDC lists total deaths at 1,018,578. What percentage of this do you think are likely to be fraudulent? Feel free to speculate wildly. 1% 10%? 30%? 50%? Even 50% -- which seems wildly imaginative to me, having cared for extremely sick COVID patients regularly for years now -- would leave us with 500,000 deaths... a "very large denominator" to me. And given the single news report that's been submitted as evidence so far...
Again, even if there were 10,000 such cases of fraud, we'd be talking about a mere 1% of deaths. And I don't see why physicians would be so motivated to commit widespread fraud in such a discoverable fashion (medical examiners reviewing cases -- physicians are generally leery about legal entanglements), and I don't see why my individual experience would be systematically biased to hide this from me as compared to the general physician experience.
> We have solid evidence that it was originally counted as a COVID death. People then looked for evidence that it was ever corrected but failed to find any. How is that "no evidence behind [my] speculation"?
So far, you have a single news story from Fox Orlando, which admits that it's unknown whether or not the issue was corrected. How is that evidence? For example, I don't know if my dead great grandmother cast fraudulent votes for Biden. Is this evidence of widespread election fraud?
> Are you saying I should just blindly trust that all of the ones we don't have information on are correct? That seems like it'd be a stretch even if we didn't have any evidence that any were ever misclassified.
No. I'm saying that it's a "stretch" to assume that the common case is a bad faith attempt to pull the wool over your eyes.
Have you ever seen a death certificate form, or been part of filling one out? I think there is also room for misunderstanding and miscommunication based on how these work (which I assume varies by state).
For cases as clear-cut as this motorcycle accident, my wild speculation would be 2-5%. But I think there were way, way more "gray area" cases that all got recorded as COVID deaths, e.g., people with advanced cancer who caught COVID and then died not long after.
> For example, I don't know if my dead great grandmother cast fraudulent votes for Biden. Is this evidence of widespread election fraud?
A better analogy would be if there were solid evidence of a provisional ballot cast in your dead great grandmother's name, and there just wasn't any evidence as to whether they counted it or threw it out.
> Have you ever seen a death certificate form, or been part of filling one out? I think there is also room for misunderstanding and miscommunication based on how these work (which I assume varies by state).
I have not.
That seems higher than I would guess, but lower than I thought you would guess. So even at the high end, and if you think perhaps 40% of COVID deaths are gray area (and so let's split that 40% and say that 20% are on the "wrong side" of gray), that would make 75% of a very large number of deaths fall into the "legitimate" zone.
> A better analogy would be if there were solid evidence of a provisional ballot cast in your dead great grandmother's name, and there just wasn't any evidence as to whether they counted it or threw it out.
I'll bite. Is that evidence of widespread election fraud? (And if so, perhaps we disagree on what "widespread" means, and whether fraud and attempted fraud should be treated separately.)
> But I think there were way, way more "gray area" cases that all got recorded as COVID deaths, e.g., people with advanced cancer who caught COVID and then died not long after.
> I have not [had experience with death certificates]
I think these two thoughts are related.
The death certificates I've done include multiple causes of death, usually a primary or immediate cause and secondary or contributing causes.
When a patient comes into my emergency department and dies of a heart attack, I am going to list the heart attack as the cause of death -- not the decades of untreated diabetes, uncontrolled hypertension, smoking, and obesity that some opine "really" caused the death. I may list those factors as secondary or contributing causes (if I know about them -- sometimes, as an emergency physician, I know nothing about the person's background and may not even have time to obtain any testing before they pass away).
I would bet that a very high proportion of well-meaning good-faith physicians would do likewise -- that is death from the primary or immediate cause of "heart attack." There is no dishonesty there.
When a patient with end-stage cancer comes into my emergency department and dies of COVID, I am going to list the COVID as the immediate cause of death, not the cancer.
When a patient with alcoholism dies in a drunken car accident, what should be the cause of death? I would argue "car accident," not alcoholism, or COVID.
However, it seems that many people who cling to "cancer" as the cause of death don't bat an eye when someone dies of a "heart attack." What about having end-stage cancer makes Monday-morning quarterbacks forget that having COVID is a legitimate cause of death?