There are a lot of conspiracy theories going around about what Dr. Birx said on TV about adding COVID-19 as a cause of death when patients die during this pandemic, concerns that we are “inflating the numbers.” Allow me to explain the process of doing a death certificate for someone who dies in the hospital (it’s slightly different for a primary care physician whose patient dies at home or elsewhere).
I log on to the New York State Electronic Death Registration System. I locate the patient within the system and fill in pertinent information about the date and time of their death, and the location. Then I have to fill in causes of death. I have to consider the immediate cause of death - usually cardiac arrest or respiratory failure. However, my job for the form is to think about what caused that situation: pneumonia, septic shock due to an infection, drug overdose, whatever it is. Then I fill in contributing disease factors - chronic heart disease, alcohol abuse, etc. Below is an example.
Yes, a lot of my death certificates during this time are going to have COVID-19 in that main cause line. Why? Because people are dying and will continue to die of COVID-19. The tests are not 100% sensitive or specific, meaning there will be false positives and negatives. Don’t focus on the actual number. What that means is that for all of these cases, I have to use what was taught to me over the course of my decade of training and career so far: clinical judgement.
I guarantee you that no doctor, nurse practitioner, or physician assistant worth a damn is going to willy-nilly put COVID-19 on a death certificate unless they have substantial reason to think that that was the cause. Not only because we’ve been trained, but because our patients mean too much to us. These aren’t statistics to those of us on the front lines. These are people. We treat their lives with respect and we treat their deaths with respect.
So stop spreading conspiracy theories that we’re trying to “inflate the numbers.” The numbers are going up all by themselves. Stay home when you can. Wash your hands, sneeze into your elbow, and wear a mask (every bit of protection counts) when you can’t. Stop gathering in large groups and putting everyone and their loved ones in danger.
Because more than ever before, it is emotionally draining to fill out death certificates.
