The CDC shows up to debunk the Washington Post's inaccurate opinion on Covid counts.

Before I get to the main topic today, just a brief work of celebration to share with you. That’s right: good news! My friend and colleague Dr. Megan Ranney was announced as the incoming Dean of the Yale School of Public Health yesterday. She’ll depart Brown University, after a long and successful run there.

Until now, the YSPH has been a part of the medical school down in New Haven. However, in its reboot, the school will be independent. So this is a major moment. With $100 million headed for the school’s endowment and up to $50 million more in matching funds in the next five years, this school is poised to be a powerful leader in the field. We had Dr. Ranney on a live Q&A back when we were on Bulletin, and we’ll try to get her back here to take questions on how she thinks a modern school of public health should train the next generation of experts.

Congratulations future Dean Ranney!

---

Now on to the main topic for today.

CDC Chief Medical Officer Dr. Debra Houry published a rebuttal to a Washington Post opinion piece from earlier this month that incorrectly claimed we are overcounting Covid-19 deaths. As you all know, I spent a lot of time correcting the records on the errors via two separate columns here on Inside Medicine. But it was nice to have someone of Dr. Houry’s status and expertise chime in. (While I’ve known Dr. Houry professionally for a while, I had no idea this was coming. So this was a pleasant surprise).

I am reproducing it below, even though it’s behind a paywall at the Post. Putting the correction of misinformation that the Post itself published behind a paywall is preposterous. Seriously WaPo, do better. (Sidebar: I have written for the opinion pages there in the past, and I respect many of the Post’s editors—I honestly don’t know what’s going on over there lately.) Anyway, if reposting Dr. Houry’s letter here is a copyright violation, I’ll insulate myself from a nasty demand letter from legal by saying that I am reproducing the letter here so that you’ll know that I’m talking about as I comment on it. That’s Fair Use. Read on….

---

We are not overcounting covid deaths in the United States.

Covid-19 deaths are not being overcounted in the United States. However, we see how there can be some confusion in understanding how covid death data is collected and reported, especially compared with hospitalization data.

The Centers for Disease Control and Prevention gathers data on deaths in multiple ways, including daily reports from health departments, which give the earliest look at trends in deaths. The most reliable way CDC gathers data on covid deaths is through provisional covid death counts based solely on death certificates, which take a bit more time to collect and report. When comparing deaths reported in these two systems, we see similar trends, which gives us confidence in their accuracy.

The CDC has detailed guidance on reporting covid deaths, outlined in the National Vital Statistics System’s Guidance for Certifying Deaths Due to Coronavirus Disease. This guidance clearly states that covid should be included on a death certificate only if it directly caused or contributed to a patient’s death.

The CDC is clear that hospitalization data displayed in agency reporting includes all people testing positive for the coronavirus, regardless of reason for hospital admission. Therefore, covid hospitalization data includes patients who were hospitalized because of covid, patients who were hospitalized for another condition that was likely made worse by having covid and patients who were hospitalized for reasons unrelated to the virus but tested positive while hospitalized.

Accurate, transparent and accessible data is critical to our understanding of any illness, outbreak or public health threat. The CDC has made great strides in making timely and transparent data available.

More than 1 million people have died in the United States from covid. Each one of these deaths is a tragic loss that should be remembered as a person, not a statistic.

Debra Houry, Atlanta

The writer is the chief medical officer of the Centers for Disease Control and Prevention.

---

The first thing you’ll note is the simple headline. If directly contradicts what the Post printed earlier in the month. The difference is that this time the essay is backed by relevant facts, delivered by an expert who in turn drew on the work of domain experts.

Second, you’ll note that there’s a direct refutation of the claim that Covid routinely shows up on death certificates where it had no business appearing.

Third, Dr. Houry explains that Covid deaths may actually take some time to be finalized in the CDC’s ledgers. Several-month lag times on completing those adjudications should not be confused for lower rates of Covid.

Fourth, as I wrote too, the issue of hospitalization data is addressed. What Dr. Houry seems to be doing here is to describe the different standards for how the CDC advises hospitals and public health officials at various levels to track and report Covid deaths versus Covid hospitalizations. Basically, she says the death certificates should include some but not all patients who died while infected with SARS-CoV-2—but that CDC reporting on hospitalization follows a far looser standard. What she’s really saying is what I wrote a couple weeks ago: trying to say something about overall Covid-19 mortality by commenting on the difference between patients who were hospitalized for Covid as opposed to with Covid is a non-sequitur.

I’ll close by noting that the CDC rarely responds to errors made by prominent voices in public health. So perhaps the impetus for replying to this one was that its experts thought the original Post column was simply that egregious. Or maybe this is a sign that the CDC will finally start doing this type of thing more often—which would probably be good—except when they get it wrong, in which case I’ll be back here telling you it’s terrible!

Make no mistake. Nothing at the CDC gets published in the media without multiple rounds of edits and suggestions from a dizzying number of inside stakeholders. I’ve seen this in action in my personal experience working with them. The CDC is often handcuffed by its own baroque processes. This is the blessing and the curse of the CDC’s current set-up. They’re so careful when it comes to stuff like this that it can take 5-10 news cycles for them to respond. So for them to have gotten this piece through the approval process in just a couple of weeks speaks to just how badly the CDC felt it had to correct the record. So, kudos to Dr. Houry and the agency for getting this one done.