I have long been suspicious of the official statistics on Covid deaths in the United States. Now it appears there were good reasons to be suspicious.
Leslie Bienen and Margery Smelkinson, writing in The Wall Street Journal, tells us public-health experts are finally coming clean by acknowledging what has long been obvious: America is overcounting hospitalizations and deaths from Covid-19. The reasons for this come down to money – hospital reimbursements from third-party insurers, especially the government.
Hospital patients are now routinely tested for Covid on admission, regardless of their admitting diagnosis, then counted as “Covid hospitalizations” even if they’re asymptomatic. Leana Wen writes in a Washington Post column, when patients die Covid is often listed on their death certificates even if it played no part in killing them. Government programs created incentives to overestimate Covid’s toll, and poor data make it difficult to pinpoint who’s still at risk and how effective boosters are.
The Centers for Disease Control and Prevention (CDC) states a positive Covid test is enough to identify a “Covid hospitalization.” We have long since seen how the CDC gets its marching orders from this White House and acts according to their political agenda. While increasing the number of Covid deaths artificially may seem counterintuitive to the interests of the White House, it does make it easier to continue their declared Covid emergency, which furthers their political agenda in other ways such as keeping more people eligible for Medicaid regardless of their financial means.
A few states and hospital systems have taken it on themselves to analyze their hospitalization data more thoroughly. Massachusetts requires hospitals to report how many of their Covid-positive patients have received dexamethasone, a standard treatment for Covid-induced lung inflammation. Using this method, the proportion of Covid-positive patients hospitalized for their Covid symptoms is only around 30%, though it fluctuates.
The UC San Francisco hospital system is using remdesivir, a Covid-19 antiviral drug, as a similar proxy. This results in higher numbers than using dexamethasone, since remdesivir is given to patients with milder symptoms. UCSF doesn’t report detailed data publicly, but hospitalizations “from Covid” are typically less than half of Covid-positive patients. The CDC, however, ignores these efforts to discern which hospitalizations were actually caused by Covid when it reports its data.
The CDC Data Tracker also uses state-generated data in reporting hundreds of daily Covid deaths. Many states report a “Covid death” anytime the decedent had a positive PCR test in the last two months before dying. Some are using death certificates, which may be more reliable, but even death certificates can be problematic because government policies create incentives to overcount.
Here’s how: Under the federal public-health emergency, which just began its fourth year, hospitals get a 20% bonus for treating Medicare patients diagnosed with Covid-19. That amounts to about a $35,000 average additional payment for each Covid patient. That may have made some sense at the beginning of the pandemic, when hospitals were swamped with seriously ill patients, subjected to arduous protocols and losing money from canceled elective surgery. But it is long since irrational under current circumstances.
As a doctor, I can tell you it makes no sense to test a patient for Covid who is in otherwise good health about to undergo an elective orthopedic procedure. But what hospital wouldn’t gladly accept the extra $35,000 if the patient just happens to test positive for Covid? It only makes sense to test those patients admitted with respiratory illness for whom a Covid-19 diagnosis would impact their treatment.
Another incentive to overcount comes from the American Rescue Plan of 2021, that large Covid relief bill passed by Congress in the early days of the Biden Administration. It authorized the Federal Emergency Management Agency (FEMA) to pay Covid-19 death benefits for funeral services, cremation, caskets, travel and a host of other expenses. The benefit is worth as much as $9,000 a person or $35,000 a family if multiple members die. By the end of 2022, FEMA had paid out nearly $2.9 billion in Covid-19 death expenses.
Many physicians report being pressured by hospitals and families to list Covid-19 on the death certificate, even when it had nothing to do with the death of the deceased. “Just try and leave Covid off the death certificate of a person who was asymptomatic positive and died in a car accident,” said one infectious disease doctor. “Just try.” These doctors were unwilling to be quoted by name for fear of reprisals from the hospitals they work for who are falsifying the death certificates.
This overcounting of deaths from Covid not only raises the costs of Covid for third-party payers, but falsely raise the fear of the public. The authors summarize: “These programs create a vicious circle. The overstatement provides a justification to continue the state of emergency, which keeps the perverse incentives going. With effective vaccines and treatments widely available, and an infection fatality rate on par with flu, it’s past time to recognize that Covid is no longer an emergency requiring special policies.”
(Dr. Bienen is a veterinarian who conducts research on zoonotic diseases and public-health policy. Ms. Smelkinson is an infectious-disease scientist whose research has focused on influenza and SARS-CoV-2 (Covid-19).
