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.
I am glad that they responded to this. While they may not need to respond to everything, this was one thing that needed a response. I also dislike journalist who lack a health journalism background writing about anything health related. Oftentimes, it’s disjointed and inaccurate.
Congrats to Megan Ranney and Deb Houry both! Just a note about the Yale SPH: their relatively new, young, smart, and energetic Health Policy chief is Jason Hockenberry PhD, a former colleague here at Emory. This is a guy who was well-integrated with the EM department here (several joint publications, especially well informed on the Obs and Urgent Care worlds). He has a great ground-level understanding of our business, having socialized amongst us many times. I hope Megan can leverage that know-how!
This is strange they made this paywalled, especially considering so much of WaPo Covid content has been free. Anyway, if you weren't aware you can "gift" articles from Washington Post, New York Times, etc which would bypass any potential conflict. Alternatively archived links bypass paywalls too like this: https://archive.ph/MhylB
That said, I think this statement by Dr Houry appears to be false "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." [I can picture sighing now "oh lord, here it comes, a book long paragraph from Mike" :) ]
I am still going through it, but with a quick pass at the 287 covid deaths in the 0-14 age cohort during 2021 you can see they included 4 accidental deaths, 1 suicide, and 4 "pending investigation deaths" where the only question is if the death was accidental, intentional homicide, or suicide (methadone poisoning for example). There are others classified as "Natural", but were mistakes (a 1 year old drowning at home is not "natural" - that is clearly a mistake)
Yes, 10 out of 287 is only 3%, but I think that is enough to falsify the claim made by Dr Houry that in fact, despite what the CDC's guidance, non-Covid related deaths are still making it through to Wonder as Covid related deaths.
Those are just the low hanging fruit, but on further scrutiny many more Covid deaths appear to be "with Covid" and not "Because of Covid".
There are for example, 7 extreme premies included, 4 of whom lived less than 10 minutes. We know that the survival rate of premies born < 24 weeks is under 10%. Almost all of these had multiple problems listed (Staphylococcal infection; Bacterial sepsis; Primary atelectasis of newborn, etc) which even without Covid 19 present drops survival rate below 1%.
As you continue to go through the list you 20 had genetic problems including Edwards, Patau, Down Syndrome(s), and MR, which unfortunately have very low expected lifespans. A dozen more have non-genetic abnormalities including cerebal palsy, multiple sclerosis, epilepsy and seizures, etc.
Many more are complex multiple causes where you could make an argument, prior to mass PCR testing, we wouldn't have noticed that a 1 year old who died from a combination of Acute Renal Failure, a Gastrointestinal hemorrhage, leukocytoclastic vasculitis, AND had a C-Diff infection, ALSO happened to have a coronavirus infection within the last 30 days. Possibly Covid lead to the kidney failure, which lead to the hemorrhage, and something caused the allergic reaction to the blood vessels, which with a compromised immune systems lead to the C-Diff infection. Or, perhaps the baby was born with bad kidneys, which lead to frequent hospitalizations, which lead to HAI such as C-Diff and Covid 19.
I am not intending to sound callous in my appraisal of this data - it's just how I communicate when talking data on morbid subjects. As a parent I know that the loss of a child is the worst thing you can experience, and my heart aches for everyone of these children and their families.
It's possible that compassion lead their medical caregivers to be generous in including Covid 19 as a contributing cause of death for many (possibly a majority) of these deaths. That generosity could slightly lighten the immense burden for these parents by at the very least providing financial assistance with the horrible prospect of burying your child, as the FEMA assistance program could pay up to $9,000 *if* Covid was a contributing cause of death. [1]
It creates a benign yet perverse incentive for coding deaths in a specific way, albeit with the best of intentions.
If this was the case, then we need to be careful using this data to make the argument that Covid is a threat to children and use that to justify policies which do them more harm than good when the underlying data needs context.
Side note - it would be pocket change to provide this coverage to all families who lose a child, regardless of cause (I calculate the money spent on 3-4 days of PCR tests alone could cover the yearly expenses for the ~30,000 deaths in children under 15)
I am glad that they responded to this. While they may not need to respond to everything, this was one thing that needed a response. I also dislike journalist who lack a health journalism background writing about anything health related. Oftentimes, it’s disjointed and inaccurate.
Congrats to Megan Ranney and Deb Houry both! Just a note about the Yale SPH: their relatively new, young, smart, and energetic Health Policy chief is Jason Hockenberry PhD, a former colleague here at Emory. This is a guy who was well-integrated with the EM department here (several joint publications, especially well informed on the Obs and Urgent Care worlds). He has a great ground-level understanding of our business, having socialized amongst us many times. I hope Megan can leverage that know-how!
This is strange they made this paywalled, especially considering so much of WaPo Covid content has been free. Anyway, if you weren't aware you can "gift" articles from Washington Post, New York Times, etc which would bypass any potential conflict. Alternatively archived links bypass paywalls too like this: https://archive.ph/MhylB
That said, I think this statement by Dr Houry appears to be false "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." [I can picture sighing now "oh lord, here it comes, a book long paragraph from Mike" :) ]
The CDC earlier this week posted detailed files on cause of death here: https://www.cdc.gov/nchs/data_access/VitalStatsOnline.htm#Mortality_Multiple (I shared this link yesterday in comment on older post too)
I am still going through it, but with a quick pass at the 287 covid deaths in the 0-14 age cohort during 2021 you can see they included 4 accidental deaths, 1 suicide, and 4 "pending investigation deaths" where the only question is if the death was accidental, intentional homicide, or suicide (methadone poisoning for example). There are others classified as "Natural", but were mistakes (a 1 year old drowning at home is not "natural" - that is clearly a mistake)
Yes, 10 out of 287 is only 3%, but I think that is enough to falsify the claim made by Dr Houry that in fact, despite what the CDC's guidance, non-Covid related deaths are still making it through to Wonder as Covid related deaths.
Those are just the low hanging fruit, but on further scrutiny many more Covid deaths appear to be "with Covid" and not "Because of Covid".
There are for example, 7 extreme premies included, 4 of whom lived less than 10 minutes. We know that the survival rate of premies born < 24 weeks is under 10%. Almost all of these had multiple problems listed (Staphylococcal infection; Bacterial sepsis; Primary atelectasis of newborn, etc) which even without Covid 19 present drops survival rate below 1%.
As you continue to go through the list you 20 had genetic problems including Edwards, Patau, Down Syndrome(s), and MR, which unfortunately have very low expected lifespans. A dozen more have non-genetic abnormalities including cerebal palsy, multiple sclerosis, epilepsy and seizures, etc.
Many more are complex multiple causes where you could make an argument, prior to mass PCR testing, we wouldn't have noticed that a 1 year old who died from a combination of Acute Renal Failure, a Gastrointestinal hemorrhage, leukocytoclastic vasculitis, AND had a C-Diff infection, ALSO happened to have a coronavirus infection within the last 30 days. Possibly Covid lead to the kidney failure, which lead to the hemorrhage, and something caused the allergic reaction to the blood vessels, which with a compromised immune systems lead to the C-Diff infection. Or, perhaps the baby was born with bad kidneys, which lead to frequent hospitalizations, which lead to HAI such as C-Diff and Covid 19.
I am not intending to sound callous in my appraisal of this data - it's just how I communicate when talking data on morbid subjects. As a parent I know that the loss of a child is the worst thing you can experience, and my heart aches for everyone of these children and their families.
It's possible that compassion lead their medical caregivers to be generous in including Covid 19 as a contributing cause of death for many (possibly a majority) of these deaths. That generosity could slightly lighten the immense burden for these parents by at the very least providing financial assistance with the horrible prospect of burying your child, as the FEMA assistance program could pay up to $9,000 *if* Covid was a contributing cause of death. [1]
It creates a benign yet perverse incentive for coding deaths in a specific way, albeit with the best of intentions.
If this was the case, then we need to be careful using this data to make the argument that Covid is a threat to children and use that to justify policies which do them more harm than good when the underlying data needs context.
Side note - it would be pocket change to provide this coverage to all families who lose a child, regardless of cause (I calculate the money spent on 3-4 days of PCR tests alone could cover the yearly expenses for the ~30,000 deaths in children under 15)
___________
[1] https://moneywise.com/news/coronavirus/unfamiliar-stimulus-will-pay-you-for-funerals
Thank you. There are benefits to admitting one is wrong when one is wrong, which has escaped some “experts” and the Post.