ForeverMask and NeverVax

Both have gotten COVID wrong for ideological reasons, and all of us have paid the costs

Just up Friday on American Mind

A good friend asked me over email about the COVID mortality counting and whether it might be important to get into the question of how many of those claimed dead of COVID had died from it and how many had died with it. Below is the response I gave to that question.

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The best evidence so far as I understand it points to undercounting of COVID deaths, not overcounting, in the US and elsewhere.

(This link does a good job of walking through some of the complexity involved in counting, while supporting the higher likelihood of undercounting.)

We know with near certainty that many urban centers with lots of COVID cases were deliberately undercounting COVID deaths.

There isn't much doubt in my mind that a very significant number of poor people who died at home of COVID and were never tested or even seen by doctors while ill avoided COVID death classification.

I'm not a big fan of the "died from or with COVID" position, frankly. This is a complicated question, for sure, but there's no solid evidentiary ground on which to legitimate such radical skepticism about COVID provoking deaths here, or at least if we're going to do it here we should be doing it consistently for all disease that has differential health burden depending on the overall health of the patient, which is a lot of disease.

The way it's used too often insinuates that because e.g., someone has co-morbidities and dies after contracting COVID, the death is somehow caused by the co-morbidities alone, or any combination of them, really, so long as COVID is taken out of the equation. But if someone has X body of co-morbidity conditions and then you add COVID, and death then occurs, it's perfectly medically legitimate to talk about the death as caused by COVID. See again the AAMC link above.

COVID's likelihood of severity is related to co-morbidities, certainly, and one can talk theoretically about how, if Americans as a whole were healthier, less obese, less diabetic, smoked less, etc., we'd have done better with COVID. That's very likely true. But the situation on the ground is the situation on the ground. Many, many people do have co-morbidities, and they do less well with COVID, but this is not an argument that COVID was not the ultimate agent of their death. They were after all living with the co-morbidities at the time of COVID infection.

I think it's worth noting that we never heard, so far as I can recall, the "from or with" language with respect to flu deaths annually, when the case is pretty much exactly the same. Who in the adult population is most likely to die from flu in any given year? The elderly and people with other chronic health conditions, i.e., co-morbidities. Do they then die from or with the flu?

I think that way of looking at things is as broadly unproductive, or at least as distant from the most important issues, there as it is with COVID. And I also think Fox News and much of the populist right media (some of which I’ve written for, to be perfectly transparent, though not on this issue because those sites generally won’t tolerate anything on this topic that is critical of their ideological line) banging this drum are not really interested in trying to drill down to the facts on COVID. They just want to beat up on the medical establishment and the left and excite their viewers/readers who are likewise more interested in that than knowing what's actually going on with COVID.

It's quite hard to find the right register for talking about COVID severity, but we have to work as hard as we can to find that proper tone, and to avoid the simplistic bromides of the ForeverMaskers and the NeverVaxers. I'd have done it at greater length in this article, but they wanted a short piece. "Not the Black Death by a long shot, but many, many times more serious than the flu" is in my read of the evidence a pretty good short summary. Even if you cut official US COVID deaths in half, this is still a public health crisis that makes any flu year in recent memory look like a small thing in comparison.