Definitions, explained in the context of COVID-19:
Comorbidity: A health condition that exists at the same time as another condition.
Pre-existing condition: A health condition or risk factor that existed before a person became sick.
Comorbidities can be caused by COVID-19 OR comorbidities can be pre-existing conditions and contribute to complications of COVID-19.
Example 1: A healthy person contracts COVID-19, which leads to pneumonia, which leads to respiratory failure, which leads to sepsis, which leads to death. Pneumonia, respiratory failure and sepsis are all comorbidities with COVID-19.
Example 2: A person who already has diabetes and hypertension contracts COVID-19. These risk factors make the person more susceptible to the effects of COVID-19, and the person dies. Diabetes and hypertension are comorbidities with COVID-19.
Background
The question of how public health officials count deaths related to COVID-19 has resurfaced this past weekend after the CDC updated death information on its website and some misunderstood what the information meant.
The CDC publishes a page titled Weekly Updates. Under the “Comorbidities” headline, some took issue with this line (emphasis is ours):
For 6% of the deaths, COVID-19 was the only cause mentioned. For deaths with conditions or causes in addition to COVID-19, on average, there were 2.6 additional conditions or causes per death.
CDC
What is really just a description of the completeness of a small percentage of death certificates nationwide spiraled into a conspiracy theory about how many people have died because of COVID-19. Unfortunately, some have taken that sentence to mean that “only 6% of deaths were caused by COVID-19.”
The fact is…
… that 6% of the COVID-19 death certificates nationwide mention only COVID-19 as the cause of death, without describing a succession of causes. Most other death certificates might look like the following example and will include comorbidities, or coexisting conditions. In the example below, the comorbid conditions came after and because of COVID-19. Many other certificates also include comorbid pre-existing conditions that caused complications and worsened the person’s outcome.
Ideally, all death certificates will indicate a clear chain of factors in the cause of death, like the example above. We know that people don’t die from a virus itself. It’s the disease the virus causes and the resulting conditions — pneumonia, hypoxia, organ failure — that lead to death. On the certificate above, it’s clearly stated. You can read more about the effects of COVID-19 on the human body in our blog post here.
The 6% of certificates that listed only COVID-19 simply did not provide the explanatory pathway of conditions. The CDC doesn’t tell us why. But they report that “lack of specificity” is among the common problems with death certificates and that “the level of completeness varies.” We know there are many overworked medical professionals. The CDC gives detailed instructions for reporting that can be found here.
The main thing to remember is that all COVID-19 death certificates list COVID-19 as at least a contributing cause of death. And the vast majority — 94%, according to the CDC’s technical notes — list it as THE underlying cause of death, meaning the condition “which initiated the train of morbid events leading directly to death.”
How COVID-19 deaths are certified in Utah
Early on in the pandemic, Utah Department of Health began publicly reporting deaths caused by COVID-19, which means that COVID-19 was the underlying condition that led to a person’s death.
In other words, the person would still be alive if it weren’t for contracting COVID-19.
Most of the COVID-19 deaths in Utah are certified by a person’s attending medical doctor, and we know that most Utah deaths have happened in a hospital setting or long-term care facility.
Because the State of Utah wants to certify effect of COVID-19 in our community, the Office of the State Medical Examiner, headed by Dr. Erik Christensen, has undertaken a review of every Utah death that is thought to be COVID-19 related to ensure what role COVID-19 played in death. This extra review gives us confidence that the number of deaths we have reported, 409 as of Sept. 1, 2020, is accurate.
We go in-depth on this topic on our COVID-19 Deaths in Utah page.
Please watch the following discussion between Nate Carlisle, a reporter from the Salt Lake Tribune, State Medical Examiner Dr. Erik Christensen, and Dr. Marion Bishop, an emergency room doctor in Utah and Wyoming. This was part of a “Trib Talk” chat uploaded August 3, 2020. This clip starts at 3:23:
The bottom line is that Utah is taking extra care, using our state experts, to present accurate data to the public.
What’s next?
You can review the latest case count information on the website so you can help track our state’s progress as we work to improve the situation for all Utahns.
Please remember to stay home if you’re sick, to wear a mask if you are around others and to wash your hands.
By working together, we can slow the spread of COVID-19 for the greater good.