“With” vs. “Of”

Rarely do I ever argue outright with a specialist or a surgeon.  The reason is simply, that they usually know more about the given problem for which I have consulted them than I do.  For instance, I’m not an epidemiologist and would by habit defer to them on questions of pandemics.

And then I read “The federal government is classifying the deaths of patients infected with the coronavirus as COVID-19 deaths, regardless of any underlying health issues…”  White House expert and daily celebrated press briefer Dr. Deborah Birx said, “Some countries are recording that as a heart issue or a kidney issue and not a COVID-19 death.

The intent is … if someone dies with COVID-19 we are counting that.”  

“Asked whether the numbers could skew data the government is trying to collect, Birx said that would mostly apply more to rural areas where testing isn’t being implemented on a wide scale.”

We do not know truly how many are infected, or have been, and therefore have no good handle on the mortality rate.  This seems contrary to everything we learned in medical school.  When we fill out death certificates, we are supposed to write the actual cause of death, followed by contributors.  It makes sense to determine that a COPD patient fitting the clinical course was killed by COVID-19.  But was the chain smoker who presented with chest pain and died of his fourth MI, subsequently found to have been COVID-19 infected, necessarily killed by the virus?  Isn’t that relevant when these numbers are being used to impact the daily lives and futures of hundreds of millions? 

Perish the thought that I would be skeptical of non-stop policy edicts handed down by well-meaning bureaucrats, but I’m not sure this is how it is supposed to work.  Dying WITH something is not necessarily the same as dying OF something, and I don’t recall this being done for H1N1, or the yearly flu waves.  And let me quickly add that I get that this virus seems nastier and more virulent than many others, lest I be burned as a heretic by those of you already reaching for the lighter fluid just because I’m wondering this out loud.  If I’m missing something, please, someone make sense of this.  If I’m right, then why is this being done?

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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  10 comments for ““With” vs. “Of”

  1. arf
    April 13, 2020 at 1:45 pm
  2. arf
    April 13, 2020 at 1:05 am

    I wonder if we have data on all-cause mortality for the first quarter of 2020.
    I wonder if it is significantly changed from 2019.
    What I’m getting at, are the 20,000 coronavirus deaths displacing other causes of death, or is it in addition?
    20,000 deaths is a tragedy, but must recognize 2.8 million all-cause deaths in USA, so about 7,600 daily.
    Specifically, influenza as one example. Will we see fewer influenza deaths in 2020? Usually about 50,000 influenza deaths annually in USA. Are we seeing people die of coronavirus, who would have died of influenza or other respiratory infection.

    I have no respect for the politicians who get on their high horse about not putting a price on life. That’s a damn lie, they politicians do that every day. Otherwise the speed limit would be five miles an hour.
    There was an Amtrak disaster in Washington State, because of failure to install safety devices on a new track run, took a curve too fast and ran off the bridge. The safety devices weren’t installed. We had bridge failures because of deferred maintenance. The State had plenty of money to prosecute church lady florists and bakers who have a problem with same-sex marriages. A couple of lawyer salaries might have paid for the train safety devices.

  3. Rick
    April 12, 2020 at 2:21 pm

    Never forget, Birx and Fauci and bureaucrats first and foremost. They conduct themselves accordingly.

  4. Diane Bergmann
    April 12, 2020 at 10:15 am

    I thought the same when I heard that. Political bullshit and scare tactics so the numbers can be used how they wish. I do not trust any of their statistics until there is reliable wide-spread testing. Cause of death should be what killed you. Not what could have.

  5. Martha Clark, RN
    April 12, 2020 at 9:41 am

    You’re right!

  6. Sir Lance-a-lot
    April 12, 2020 at 8:36 am

    Okay, Pat…

    First, Birx is a political a-hole of the highest order.
    My wife had dealings with her between 10 and 20 years ago regarding the Medical Reserve Corps (an organizing structure set up as part of the AmeriCorps program in the ’90s, intended to create a system of self-managed volunteer organizations of pre-credentialed medical professionals and ancillary people, who could be quickly mobilized in cases of emergency, which was expanded after 9/11 and Katrina, and ultimately became a classic Federal boondoggle, funneling unimaginable amounts of money to a variety of private interests while the original volunteers were left out in the cold), so I am confident of this.
    First time she got up in front of a news conference, my wife said, “Oh my God, not her!”

    Second, your instinct to believe the specialists is exactly right.
    In this case, Dr. Birx is an Immunologist who has done work in controlling international epidemics. She has credibility in these areas.
    What she is not is a Pathologist.
    So, she really should have nothing to say about cause, contributors, and manner of death. This is the realm of the Medical Examiner or Coroner, and, as you say, may list COVID-19 as cause with CAD contributing, or may list AMI due to CAD, with COVID-19 contributing.
    Personally, I think it fair to list all deaths where COVID contributes significantly as COVID deaths, but that is an area of legitimate disagreement.

    Third, just for an example:
    NYC lists about 5,000 deaths so far from the ‘Rona (could be 6,000 by the time you read this). These are all inpatient deaths in pts who have been tested.
    NYC has also experienced something like 8 times more home deaths over the past month or so than normal (sorry, I’m not going to look for the exact number), which adds up to about 5,000 more deaths than this time in any preceding year. None of these people gets tested post mortem for the ‘Rona. They’ve barely got the resources to get ’em in the ground (and they’re doing that in stacked in trenches with bulldozers on Hart Island).
    Tested or not, these people are unquestionably victims of the same agent (unless you want to posit a new one), so it is reasonable to include them in the COVID numbers, even if the CME or their own doctors listed “cardiac arrest” or “respiratory arrest” as their cause of death.

    • Pat
      April 12, 2020 at 9:21 pm

      Lance, as ever, I truly value your point of view.

      If you were on that stage every day with Trump instead of those two self-promoters, I’d have a lot more respect for the opinions being expressed.

      Stay healthy!

    • Mamadoc
      April 15, 2020 at 8:21 pm

      Small world!

  7. Dr Bonz
    April 12, 2020 at 8:18 am

    We already know why it is being done. For POLITICAL reasons. It most certainly isn’t for MEDICAL reasons. If this was left PURELY to physicians, with no politician/bureaucratic input, it would be done exactly as you said. The way we as doctors have always done it. But this one is different. And the difference is that Donald Trump wasn’t president when we dealt with the other ones. The worse the numbers look, the higher the death toll, the worse he looks and the less chance he gets reelected.

    • arf
      April 16, 2020 at 10:57 am

      I can predict exactly when this crisis will end.
      November 4
      Right after Election Day.

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