You have already been taken to task by others but just to correct you, yet again, you picked 60K which is a very bad year for influenza. Most people, you included, probably do not know that these are estimated numbers, they are not confirmed by testing. Covid deaths (despite what idiots say) have much more scrutiny to be counted (at least a positive test) and if we used influenza metrics to count Covid deaths, the Covid numbers for both deaths and hospitalizations would be much higher.
Where in the world are you getting your Covid data collection info from? What a pile of crap your post is.
Why Did the CDC Decide to Create Unique Reporting Rules for COVID-19 When Successful Reporting Rules Already Existed?
A double standard exists for how COVID-19 data is collected and reported versus all other infectious diseases and causes of death. Let’s examine three essential data categories; Fatalities, Cases & Hospitalizations for all infectious diseases because there are significant flaws in what constitutes a COVID-19 case, hospitalization and fatality.
On March 24[SUP]th[/SUP], the CDC decided to ignore universal data collection and reporting guidelines for fatalities in favor of adopting new guidelines unique to COVID-19. The guidelines the CDC decided against using have been used successfully since 2003.
After all, based upon the July 11[SUP]th[/SUP]data from the CDC’s Provisional COVID-19 Death Counts by Sex, Age & State webpage, if COVID-19 is an epidemic (122,374 Fatalities), then shouldn’t pneumonia (131,372 Fatalities) also be an epidemic?[SUP]1[/SUP]
Fatality Data
It is important to note that COVID-19 data is collected and reported by a much different standard than all other infectious diseases and causes of death data. This unique standard for COVID-19 was used, despite the existence of guidelines that have been successfully used since 2003 for data collection across all infective, comorbid, and injurious situations.
… the rules for coding and selection of the underlying cause of death are expected to result in COVID19 being the underlying cause more often than not.
This begs the question,
if the CDC already has well established guidelines for reporting fatalities then why make up new guidelines for COVID-19?
COVID-19 data is collected and reported based upon the March 24[SUP]th[/SUP] National Vital Statistics Systems (NVSS) Guidelines and the April 14[SUP]th[/SUP] CDC adoption of a position paper authored by the Council of State and Territorial Epidemiologists (CSTE).[SUP] 8,9[/SUP]
However, the data for all other causes of death is based upon the 2003 CDC’s Medical Examiners’ & Coroners’ Handbook on Death Registration and Fetal Death Reporting and the CDC’s Physicians’ Handbook on Medical Certification of Death.[SUP] 10,11[/SUP]
On March 24[SUP]th[/SUP], the NVSS, under the direction of the CDC and National Institute of Health (NIH), instructed physicians, medical examiners, and coroners that COVID-19 would:
- be recorded as the underlying cause of death “more often than not;”
- be recorded as the cause of death listed in Part I of the death certificate even in assumed cases;
- be recorded as the primary cause of death even if the decedent had other chronic comorbidities. All comorbidities for COVID-19 would be listed now in Part II, rather than in Part I as they had been since 2003 for all other causes of death.
March 24[SUP]th[/SUP], 2020 – NVSS COVID-19 Alert No. 2
“Will COVID-19 be the underlying cause? The underlying cause depends upon what and where conditions are reported on the death certificate.
However, the rules for coding and selection of the underlying cause of death are expected to result in COVID19 being the underlying cause more often than not.”
“Should “COVID-19” be reported on the death certificate only with a confirmed test? COVID-19 should be reported on the death certificate for all decedents where the disease caused
or is assumed to have caused or contributed to death. Certifiers should include as much detail as possible based on their knowledge of the case, medical records, laboratory testing, etc.
If the decedent had other chronic conditions such as COPD or asthma that may have also contributed, these conditions can be reported in Part II. (See attached Guidance for Certifying COVID-19 Deaths)”
It’s worth noting that Part I of a death certificate is the immediate cause of death listed in sequential order from the official cause on line item (a) to the underlying causes that contributed to death in descending order of importance on line item (d), while Part II is/are the significant conditions NOT relating to the underlying cause(s) in Part I.
As we will demonstrate shortly, comorbid conditions are always listed on Part I of death certificates as causes of death per the 2003 CDC Handbook, so that accurate reporting can be developed.
Comorbidities are seldom placed in Part II, as this is typically the place where coroners and medical examiners can list recent infections as underlying factors.
Prior to the March 24[SUP]th[/SUP] and April 14[SUP]th[/SUP] decisions, any comorbidities would have been listed in Part I rather than Part II and initiating factors, like recent infections, would have been listed on the last line in Part I or in Part II.
Why does this matter?
This matters because the Part I causes of death are statistically recorded for public health reporting, while Part II does not hold nearly the same statistical significance in reporting. This March 24[SUP]th[/SUP] NVSS guideline essentially allows COVID-19 to be the cause of death when the actual cause of death should be the comorbidity according to the industry-standard 2003 CDC Handbook. It can be a bit confusing, so we will present an example shortly for clarity.
On April 14[SUP]th[/SUP], the CDC in conjunctions with approval from the National Institute of Health (NIH), adopted the CSTE position paper that authorized the following guidelines for data collection and reporting which are completely unique for COVID-19 and had never been done before which:
- allowed for ‘Probable’ cases, hospitalizations, and fatalities [section A5];
- created a pathway for the minimum standards of evidence to be a single cough [section A1];
- created a pathway for completely bypassing laboratory testing in order to classify a COVID-19 case as positive [section A5];
- created a pathway for the minimum standard of evidence necessary for determining a COVID-19 case to be positive as being within 6 feet of a ‘Probable’ case for 10 minutes or traveling to an area with outbreaks [section A3];
- declined to create any methodology for ensuring the same COVID-19 positive person would not be counted multiple times as a new case upon being tested multiple times [section B].
April 14[SUP]th[/SUP], 2020 – CDC Adopts CSTE Interim-20-ID-01
Title: Standardized surveillance case definition and national notification for 2019 novel coronavirus disease (COVID-19)
“
VII. Case Definition for Case Classification
- Narrative: Description of criteria to determine how a case should be classified.
A1. Clinical Criteria At least two of the following symptoms:
- fever (measured or subjective), chills, rigors, myalgia, headache, sore throat, new olfactory and taste disorder(s) OR
- At least one of the following symptoms: cough, shortness of breath, or difficulty breathing OR
- Severe respiratory illness with at least one of the following:
- Clinical or radiographic evidence of pneumonia, or
- Acute respiratory distress syndrome (ARDS). AND
- No alternative more likely diagnosis
A2. Laboratory Criteria Laboratory evidence using a method approved or authorized by the FDA or designated authority:
Confirmatory laboratory evidence:
- Detection of SARS-CoV-2 RNA in a clinical specimen using a molecular amplification detection test
Presumptive laboratory evidence:
- Detection of specific antigen in a clinical specimen
- Detection of specific antibody in serum, plasma, or whole blood indicative of a new or recent infection*
*serologic methods for diagnosis are currently being defined
A3. Epidemiologic Linkage One or more of the following exposures in the 14 days before onset of symptoms:
- Close contact** with a confirmed or probable case of COVID-19 disease;or
- Close contact** with a person with:
- clinically compatible illness AND
- linkage to a confirmed case of COVID-19 disease.
- Travel to or residence in an area with sustained, ongoing community transmission of SARS-CoV2.
- Member of a risk cohort as defined by public health authorities during an outbreak.
**Close contact is defined as being within 6 feet for at least a period of 10 minutes to 30 minutes or more depending upon the exposure. In healthcare settings, this may be defined as exposures of greater than a few minutes or more. Data are insufficient to precisely define the duration of exposure that constitutes prolonged exposure and thus a close contact.
A4. Vital Records Criteria A death certificate that lists COVID-19 disease or SARS-CoV-2 as a cause of death or a significant condition contributing to death.
A5. Case Classifications
Confirmed:
- Meets confirmatory laboratory evidence.
Probable:
- Meets clinical criteria AND epidemiologic evidence with no confirmatory laboratory testing performed for COVID-19.
- Meets presumptive laboratory evidence AND either clinical criteria OR epidemiologic evidence.
- Meets vital records criteria with no confirmatory laboratory testing performed for COVID19.
- Criteria to distinguish a new case of this disease or condition from reports or notifications which should not be enumerated as a new case for surveillance
- N/A until more virologic data are available”
Additionally,
the CSTE position paper gave no definition as to what constitutes a COVID-19 recovery for all state and country health departments to follow.
While the, seemingly independent, CSTE position paper was authored by five accomplished professionals from the Idaho, Alabama, Michigan, Hawaii, and Iowa state health departments; 5 of the 7 Subject Matter Experts who contributed to the position paper were directly employed by the CDC which raises ethical concerns about conflicts of interest.