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September-October 2020

Editor’s Note: Codes as Propaganda
By Lee DeOrio
For The Record
Vol. 32 No. 5 P. 4

You may have heard that, according to a Centers for Disease Control and Prevention report, COVID-19 was the “only cause mentioned” on death certificates in 6% of deaths involving the virus. Yes, apparently lives have been overturned and destroyed for a virus that appears to be not nearly as impactful as we thought.

It’s just another outrageous take in a year of outlandishness that is making Lady Gaga’s wardrobe seem tame.

To fit the user’s narrative, data can be bent in many different ways. Technically, it may be correct but presenting it in a manner that implies facts, not evidence, is ludicrous. There is always someone who is willing to encourage public misinterpretation in order to meet their agenda.

Death certificates don’t report ICD-10 codes. To get accurate information, it would be necessary to examine the medical record of the deceased. If someone known to have COVID-19 dies—and if the coder followed the rules correctly—the coding may or may not match the information on the death certificate. Coding rules don’t always make sense clinically nor are they in line with social media or propaganda expectations. Consider two different clinical pictures of two different people, each of whom died directly from a severe COVID-19 infection.

Admitted due to a broken leg to have surgical repair, patient also had a fever and a bad cough. COVID-19 test was positive, chest X-ray showed pneumonia; surgery cancelled. The patient went into organ failure. He died from COVID-19, but the first-listed diagnosis in the record will be the broken leg because that was the worst problem and the original reason he was admitted.

A pregnant patient was admitted with a cough and fever; COVID-19 test was positive. As her condition worsened, she developed COVID-19, pneumonia, and sepsis. She died from COVID-19 but “other viral disease complicating pregnancy” will be the first code listed in the record—then the code for COVID-19, followed by any additional complications of COVID-19, followed by any additional new or chronic problems.

In any of these cases, were chronic conditions such as diabetes, hypertension, and COPD present? Older patients are more likely to have chronic conditions that can contribute to general poor health, but they had those while they were sitting at home until they were infected by COVID-19.

Isn’t it at least equally likely that it was actually COVID-19 that “contributed to the severity of the chronic conditions”? Even the patient with the broken leg had a serious problem in addition to COVID-19. Did it contribute to his death? Not likely. (It would have been on the coded diagnoses on the patient record; it shouldn’t have been on the death certificate.)

Consider Marilyn Monroe’s famous death certificate, which listed the cause of death, in order, as acute barbiturate poisoning, due to ingestion of overdose, due to “probable suicide.” So how did Marilyn die? Overdose of barbiturates, causing drug poisoning. But what caused that overdose? Probable suicide. Answer any one of the three causes and you’re correct—but you aren’t completely correct unless you include all three. Manipulating information leads us down a very dangerous path. Even today, Marilyn’s death remains the product of wild speculation.

The only thing we know for certain is that she didn’t die from COVID-19.