Data Snapshot: Unnatural Deaths Like Accidents, Trauma, and Overdose Rarely Attributed to Covid.

Debunking a misleading talking point about Covid death certificates and unnatural causes.

There’s a talking point among those who wish to minimize Covid that says we are overcounting Covid-19 deaths because some people died of trauma but happened to test positive for coronavirus. The idea is that some unnatural deaths like traumas and overdoses were incorrectly assigned to Covid, and that these deaths are proof that we are overcounting Covid deaths.

That’s not what is driving Covid mortality numbers. Let’s look at the data:

Data: CDC. Image: Benjy Renton for Inside Medicine.

The numbers speak for themselves. From the outset of the pandemic through June 30, 2022 (that’s how far the data go for this question), the CDC reported 1,019,267 deaths in which Covid-19 was anywhere on a person’s death certificate. These records included both those where Covid was the underlying (main) cause, and those where it was a secondary (contributing) cause. Of these, 89% listed Covid-19 as the underlying cause, 10.5% were deemed to have primarily died of other medical causes (e.g., heart attacks, cancer, strokes, diabetes, or even closely related causes like pneumonia), and 0.5% had some kind of unnatural event (like trauma or overdose, which we call “external” deaths) listed as the underlying cause.

You may be asking, “What’s the deal with those 0.5% who died of some kind of trauma or something?” First, that’s both a non-zero number and a small one. So, let’s look at the 5,368 deaths in the US who checked both boxes (i.e., primary cause of death was external/unnatural where a contributing cause was Covid). Of those, accidental falls (a major cause of morbidity and mortality in the elderly) was the primary cause of death for 40% of them.

What about firearm deaths? Since the pandemic began, 111 people had a firearm injury listed as their main cause of death who also had Covid listed as a secondary cause; meanwhile, there were 28 people who had Covid listed as the main cause of death who also had a firearm injury listed as a secondary cause. This is hardly a smoking gun—pardon the pun—that Covid deaths have been systematically over-reported.

These cases are rare. Anyone highlighting these deaths has either failed to consult the data, or has done so but has chosen not to put them into context by stating how rare this all is. The former is irresponsible; the latter is cynical.

As an emergency physician (and voracious consumer of data), I can tell you that when old people fall, it’s often because of some lurking medical problem. Some little old lady will fall and break her hip at home. She’ll swear that she just slipped on the stairs or something. And sometimes that’s true. But often it’s a “tell” that something else is going on. “Why did you fall today?” I often ask. After all, she probably walks those stairs every day. What changed? Why now? Was it just bad luck and her number came up?

It depends.

Very often, with just a little bit of investigation, it comes to light that something else tipped them over, so to speak. A classic example: little old lady gets a virus. She’s fine, if a little worse for the wear; she hasn’t been eating or drinking much. She’s a touch dehydrated. Nothing that would need hospitalization, but she’s definitely run down. Uncharacteristically, she becomes light-headed on the stairs and she falls. Now she has a broken hip and needs to be hospitalized. The one-year all-cause mortality on broken hips that require hospitalization is astoundingly high. Let’s say she dies a week or a month later, even. And let’s say that virus turned out to be Covid or influenza.

What killed her? Was it the fall? Was it the virus that caused her to be weak enough to fall? Was it some complication of her hip operation? Who knows? The point is that the chain of events started with the virus, not the fall.

This does not mean that every death due to a fall is incorrectly assigned to trauma. But it does mean that seeing 5,368 deaths due to unnatural causes that also had Covid on the death certificate (out of over 1 million, remember), is not gotcha proof that doctors and medical examiners are out here pumping up Covid deaths. It’s just a reflection of how messy the world is, and how dangerous even mild viral illnesses can be for older people. (This messiness is why I chose to study all-cause mortality, not just Covid mortality, during the pandemic; I wanted to track systemic effects, devoid of subjectivity whenever possible.)

Now as you can see, over time, the balance is shifting a bit. But the main story hasn’t changed. Covid is what killed most people with Covid anywhere on their death certificate.

The line between misinformation and disinformation is subtle. Basically, misinformation is unintentional while disinformation is intentionally deceptive. I don’t claim to know why people refer to the kinds of deaths we’ve been talking about here as proof that Covid deaths are exaggerated. But hopefully with these numbers, you can correct people who haven’t seen the data, have seen it and are cynically misleading others, or do not understand what they really say.