Long Covid began showing up on the death certificates of a small percentage of other people who died from the pandemic, but this tiny fraction of the records only tells the full story, two experts told STAT, while others are hesitant to draw conclusions at all.
The directory of Covid death certificates in duration as a cause of death numbered 3,544, representing 0. 3% of the 1,021,487 Covid deaths in the United States from January 2020 to June 2022, according to research released Wednesday by the National Center for Health Statistics, which is a component of the Centers for Disease Control and Prevention. To compile the report, the researchers extracted a variety of long-term Covid descriptions, adding post-acute sequelae of Covid-19, long-distance Covid, post-Covid situations, from the text written on the death certificate. Until recently, there was no express diagnostic code or consensus definition of symptoms that persist after a person’s acute Covid infection disappears.
Eric Topol, director and founder of the Scripps Research Translational Institute, dismisses the death certificate as unreliable in all areas, not just Covid. “It’s cloudy because for a long time, Covid is not known to kill other people directly,” he said. “It’s a chronic disease with a lot of ambiguity about multiple systems. It’s a mosaic of meaning, so quantifying deaths is difficult.
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Other experts say the CDC’s numbers are underestimated and, at worst, constitute a “myopic” view of other people living with covid long-term. Like Topol, they were not involved in the investigation.
“The quality of what [researchers] have done is high; the challenge is that the knowledge they have provides a basis for an estimate of the mortality burden of prolonged covid,” said Harlan Krumholz, a Yale cardiologist who has worked with prolonged covid. patients. ” I am convinced that long Covid, in addition to what it does for quality of life, is also causing deaths. “
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The report points to disparities in prolonged covid deaths that reflect the pandemic as a whole. In addition to the higher death rate among adults 85 and older and men compared to women, non-Hispanic Native Americans or Alaska Natives had a death rate more than twice as high as other people from other racial or ethnic groups. That’s because Native Americans or Alaska Natives are much more likely to die from covid or have covid as a contributing factor to their deaths for a long time, most likely because they had less fitness care, the authors wrote.
There were exceptions: Despite higher COVID-19 death rates, non-Hispanic blacks and Hispanics did not have higher long-term covid death rates than non-Hispanic whites. Black and Hispanic populations, reducing the number of COVID-19 survivors to revel in prolonged COVID conditions,” the researchers wrote.
The disparities are a sobering review of the report, but David Putrino, director of rehabilitation innovation at Mount Sinai Health System, is concerned about what he sees as serious acute infections.
“We are still incredibly short-sighted about our vision of how long covid will last. Therefore, we are not reading all the tactics that cause loss of life,” said Putrino, who introduced one of the first long-running covid clinics in the country. States Unidos. Es very, very transparent that most of those cases were similar to other people with severe acute illnesses suffering from severe acute illnesses. The fact is, there are many, many more, orders of magnitude more, from other people who didn’t have a serious acute illness at first, but then developed those very debilitating symptoms.
This leaves out other people who develop prolonged covid symptoms after a milder infection. There are also two missing causes of death after prolonged covid that do not necessarily show up on death certificates: vascular events, such as central attacks after known abnormalities in covid blood clotting, and suicide
“Mental health issues go unnoticed, but we know that other people with long-lasting covid commit suicide,” Putrino said. “It is very rare for your death certificate to be classified as similar to a long-lasting covid. the tactics in which Covid continues to cause death and loss of function. “
Reacting to STAT’s request for comment, NCHS mortality statisticians said through a CDC spokesperson that death certificates are designed in particular to identify causation, avoiding critics who call them unreliable, but acknowledging that they are infrequently not completed and that the cause of death is rare. doubtful or unknown. As for the severity of the disease, the death certificate captured the cause of death as a contributing factor, regardless of the severity of the initial Covid-19 infection. And suicide wasn’t one of the main underlying reasons for the long covid deaths.
Prolonged covid can lead to death in a number of ways, adding suicide, Krumholz said. It can exacerbate other conditions, it can cause disorders similar to your core symptoms, such as fatigue, shortness of breath, cognitive disorders, which in turn can lead to vulnerability. This can lead to loss of source of income due to lack of work, which can also lead to vulnerability. And that can lead to suicide. ” All those scenarios would be similar to the long Covid,” he said.
CDC researchers acknowledge the limitations, primarily the delay in assigning an ICD number to Covid through the diagnostic bible known as ICD-10, making it too late for analysts to use. And some other warning: “The investigation only included a death certificate stating that Covid-19 is a cause of death and would therefore possibly underestimate deaths for which a past Covid-19 infection has not been proven or suspected, but which would possibly have contributed to death. “
Topol is skeptical about building a direct line of causality between prolonged covid and death, based only on the death certificate and not on a thorough examination of a patient’s illness. “When you look at the total list of symptoms and signs, you don’t see a direct link to death. You see fatigue and shortness of breath, headaches and brain fog,” he said. “People have a disability, but they don’t know he’s a killer. “
What’s confusing, Topol added, is that there are other symptoms in many other organ systems that can occur in other people who don’t have the symptoms of prolonged covid.
“If someone had a stroke and had Covid a few months earlier, and it was an idea that the stroke was a complication of Covid, I don’t know if I would point that out on their death certificate,” he said. “I would say they had a stroke. I can’t find cause and effect. I wouldn’t think about it for so long Covid. I see this as an imaginable complication of Covid.
One of the limitations of the pandemic has been how to diagnose the long covid, how to estimate its prevalence and how to treat it. Putrino hasn’t noticed deaths among patients in his clinic, but he’s concerned about other people who aren’t getting better. “Most other people enjoy at least significant improvement in our clinic, if not a full and complete recovery,” he said. “But there’s a percentage we still don’t know how to treat. “
Krumholz said the CDC report serves a purpose: “It’s helpful to draw attention to the fact that deaths are occurring, but other people shouldn’t see that small number as anything higher than any estimate,” he said. bigger. “
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