Do you remember how the pandemic scare started in the West? It was the news coming from Italy that freaked everyone out. A report from the Italian public health agency dated March 20, 2020 was released describing the Italian catastrophe. You only have to read the first couple of pages, including the footnotes, to realize it was a scam. And if the first two pages don't do it, then the 5th absolutely will. "For 2 patients under the age of 40 years, no clinical information is available; the remaining 7 had serious pre-existing pathologies (cardiovascular, renal, psychiatric pathologies, diabetes, obesity)." – this is what was said about the COVID-19 deaths.
I did not read that report when it came out. Neither did most of the people. The few who did got ridiculed and ostracized.
Meat: Death Certificate or License to Kill?
Defining the cause of death is a tricky but important business. There are well established rules in place for medical professionals to follow when determining the “underlying cause of death”. According to Canadian Medical Association Journal,” The underlying cause is the antecedent cause that initiated the sequence of events leading to death. In other words, the underlying cause starts the chain of events, and the immediate cause is the final link in the chain.” It is important because “The underlying cause of death is the cause selected for coding and tabulation of the official cause-of-death statistics.”
COVID-19 pandemic brought in quite revolutionary corrections to certifying death, which were reflected in World Health Organisation (WHO) “International Guidelines for Certification and Classification (Coding) of COVID-19 as Cause of Death”. Those guidelines requested the participating member states to attribute death to COVID where the disease could be thought of as a contributor to death.
“COVID-19 should be recorded on the medical certificate of cause of death for ALL decedents where the disease caused, or is assumed to have caused, or contributed to death.”
WHO also advised to do the same for “probable” COVID-19 infections:
“A COVID-19 death is defined for surveillance purposes as a death resulting from a clinically compatible illness in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID-19 disease (e.g. trauma).”
It would be interesting to compare COVID fatality rates between countries that used the WHO’s request and those that did not. However, out of 195 countries in the world today, 193 are WHO member states, which renders such comparison practically unfeasible. But some observations can still be made, based on what the revised death certification practice might lead to.
An obvious concern about such an unprecedented promotion of a particular illness as the underlying cause of death, is that it would absolve severe comorbidities to the whims of PCR and other (less reliable) testing or to mere suspecting of COVID-19 infection. Indeed, for someone in a critical condition (cancer, trauma, heart attack) any, however minor, stress (think of a paper cut) can be conceived as initiating the chain as opposed to being the “final straw that broke the camel’s back”. And in case of suspected COVID infection, under the new guidelines, what goes on the death certificate as “underlying cause” becomes heavily biased toward COVID-19. Case in point, the amended certification did result in ridiculous situations where people injured in traffic or other accidents were pronounced dead of COVID (seemingly but not necessarily contrary to the WHO Guidelines).
Still, even with such bias (justified for “surveillance purposes”), according to Statistics Canada, in 2020, COVID-19 contribution to mortality (5%) was on par with accidents and quite behind from 2 leading causes: malignant neoplasm (cancer) and heart diseases (26% and 17% respectively).
It is worth noting that in the same year the contribution of cancer to the overall mortality dropped by nearly 3% (which is significantly off of its regular year-over-year <1% fluctuation). Considering that it’s been widely stated and acknowledged that cancer, due to its adverse effects on immune system, is a serious COVID-19 comorbidity, it would be reasonable to expect more cancer deaths in 2020 – not less. But if the underlying cause (and hence reporting) were switched to be the viral infection itself (in full accord with WHO’s guidelines), that’s how it should look indeed.
COVID-19 is viewed as illness of old and vulnerable. Dying from old age is not even a thing when it comes to official death causes. When an elderly dies, it has to be attributed to something other than age, even though it should be obvious that 80+ age fragility renders the cause of death determination a nominal exercise. This leads us to another interesting observation.
In Canada in 2020, life expectancy was 82 years. The average age of 15,600 Canadians who died of COVID-19 in the same year was 84 years. Of those 15,600, about 2/3 (~10,000) were over the life expectancy age. By taking those numbers at face value, it follows that elderly Canadians with COVID live longer than average! But should those 10,000 deaths be even meaningfully counted toward “COVID deaths”, considering the circumstances?
Mixing and Cooking
Combining biased death attribution with opportunistic testing can easily result in pandemic outlook for any otherwise innocuous infectious outbreak, especially if it is spiced up by the overhyped media attention.
Consider this hypothetical scenario. According to the World Health Organization, it is estimated that around 67% of the global population under the age of 50 carries HSV-1 (one of the herpes viruses). In developed countries (like Canada), the prevalence can be higher, reaching over 90% in certain groups. The percentages are obtained as statistical estimates by sampling and PCR-testing for herpes in primarily asymptomatic population. But if we start chasing down individuals with the same PCR test used as a clinical diagnostic tool assuming positive cases as “infectious”, then we will end up with at least half of the population sick. And linking deaths to those detected infections in considerable enough amounts might give some people reasons to panic.
However, it would be quite difficult to bring attention to the herpes-based “disaster” by the media, because HSV-1 is a well-known nuisance. But what if a novel highly contagious and dangerous variant (let’s call it “HSV-5”) were discovered? Who would then blame medical authorities for expanded and scrupulous herpes testing that errs on the side of caution in order to protect the vulnerable? And why not to instruct doctors and nurses to skew the records on death certificates for HSV-5 surveillance purposes? That would make the media job easier.
And if this simple recipe works, it should be recognizable in the next pandemic or even epidemic localized to a country.