by Jon Sanders
Research Editor and Senior Fellow, Regulatory Studies, John Locke Foundation
Last week I looked at how North Carolina uses a test cycle threshold that is several cycles past what the scientific consensus calls for, what virologists advise, and what the Centers for Disease Control and Prevention recommend. As a result, North Carolina’s COVID-19 case count may be highly inflated, with tests so sensitive they’re often not detecting living virus, but unviable genetic fragments that pose no risk.
If cases aren’t nearly as prevalent, then does that mean the virus is more viral and deadly than it seems? We can’t inflate hospitalizations and deaths, can we?
Good questions. Regarding hospitalizations, the state publishes a daily count of “currently hospitalized COVID-19 patients.” What does that mean, exactly?
In regular conversation, a hospitalized COVID-19 patient would mean someone whose COVID infection is so bad it’s put him in the hospital. To Gov. Roy Cooper’s Department of Health and Human Services, however, it means someone who is in the hospital for any reason and who has tested positive for COVID-19. That’s a key distinction. I’ll explain.
DHHS admits no distinction between a hospitalization for COVID and hospitalization with COVID. Hospitalizations for COVID are the dangerous infections people rightly worry about. Hospitalizations with COVID are when people are in the hospital for other reasons — a chest ailment, a car accident, a medical procedure, etc. — and as part of the routine clinical assessment, they test positive for COVID.
How many people are in one group and not the next? It’s hard to tell from this vantage point. Counting the two groups together, however, only inflates the number and gives the impression that dangerous infections are higher than they are. How much higher, who can tell?
What about deaths? Dr. Donald van der Vaart has already explained the difficulties of differentiating deaths caused directly by a virus (such as influenza or, now, COVID-19) and those caused by complications from a virus:
When a patient succumbs to a viral disease, the actual cause of death is not necessarily the virus itself. Respiratory diseases often bring complications, such as pneumonia, that can be the actual cause of death. As a result, the reporting of deaths from viruses has been imprecise.
Akin to the flu, COVID-19 may be the cause of the fatal ailment(s), or it may just be present at the end. A person could succumb from COVID-induced pneumonia, or a person who tested positive with COVID could succumb to Stage 4 cancer.
In regular conversation, a COVID infection that sets into motion the medical events that bring about a fatality is what people rightly worry about. DHHS seems to treat deaths similar to how it treats hospitalizations: death from COVID, death with COVID, it all “counts.” According to DHHS,
COVID-19 deaths include people who have had a positive molecular (PCR) or antigen test for COVID-19, who died without fully recovering from COVID-19, and who had no alternative cause of death identified.
Here again, counting the two groups together inflates the number of deaths and gives the impression that fatal COVID infections are higher than they are. How much higher, again, who can tell?
If someone died from COVID, you would think it would be known. But what if someone died with COVID? The Cooper administration’s death reporting is notoriously bad — worst in the country. But even that doesn’t explain why DHHS seems to keep finding COVID deaths months after the fact.
A day’s report of “new” COVID deaths frequently contains deaths from several weeks prior. On September 15, DHHS suddenly reported a “new” COVID death — from April 14! It’s not as if DHHS just learned of those deaths, but something has changed, weeks if not months after the fact, that causes DHHS to list those deaths as COVID deaths.
There’s another aspect to this problem: hospitals have a financial incentive to list COVID-19 on diagnostic codes. The federal CARES Act included a 20 percent increase on Medicare reimbursement rates to hospitals for patients with a COVID-19 diagnostic code. Increasing concern about such coding problems led to a September change by the Centers for Medicare and Medicaid Services to require not just a physician’s assessment to qualify, but also a positive lab test, too. Hospitals objected to this change, but as reported by the Wall Street Journal Sept. 12:
CMS is concerned that without a lab test showing someone has Covid-19, hospitals may code them incorrectly as having the virus and erroneously receive the 20% add-on. The agency said that it will review patient records after payments are made to confirm positive test results, and those lacking results would see their payments accounted for as overpayments.
Evidence suggests that hospitals could be overreporting Covid-19-related deaths for patients with certain medical conditions, such as end-stage renal disease and chronic kidney disease, according to an Aug. 20 report to CMS by Acumen, a Burlingame, Calif., provider of data analysis to government agencies.
Political considerations have so infested the Cooper administration’s reaction to the coronavirus that they have rendered vague the terms people use in everyday conversation and expect them to retain their clear meanings — cases, hospitalizations, deaths, etc. This fog of uncertainty has its short-term advantages in keeping the populace alarmed, thereby justifying unprecedented, unilateral power grabs with devastating economic consequences. It’s not responsible governing, however, and it’s hard to see how it can be sustainable over time.