While I Am on the Topic, Death Certificates in Minnesota

A reader, DDL, has been doing tremendous work, along with another reader, JL, in trying to make sense of the Minnesota death certificates, which is a thankless task, given the great variability among certifiers.   As I have noted several times, the unprecedented CDC guidance on how to attribute deaths to CV-19 (basically, if anyone dies while there is a case somewhere in the country, it must have been due to CV-19), which has been liberally employed by the states, means that many deaths that shouldn’t be, are being attributed to CV-19.  The analysis is further hampered by inconsistency in reporting by CDC and the state Department of Health, with one reporting on a week of death basis and the other just giving us reported deaths that are received on a particular day.  The two agencies also appear to have different numbers of deaths, with the CDC somehow being higher now.  Here are a couple of specific observations by the readers in regard to the Minnesota records.

One is that it is very difficult to match up the number of deaths reported by DOH to the number found by looking at death certificates.  There are issues with using the actual alpha-numeric code assigned to CV-19 deaths and when that code isn’t present or isn’t typed in right, there is a lot of inconsistency in word descriptions.  And some certificates might say “coronavirus” but would say something like “coronavirus ruled out”.  So figuring out from the death certificates which deaths the DOH attributes to CV-19 is not easy.  The state supposedly has a whole group “validating” CV-19 deaths, but I don’t know what they are using as guidelines.  Many certificates have CV-19 out of sequence, that is, the ordering of causes doesn’t make sense given the clinical presentation and guidelines.  If CV-19 is truly the cause of death, it should be the last cause listed.  The state should distinguish deaths where it is listed as the underlying cause of death, and those where it was just an intermediate cause.  And ones where it is only listed in the additional contributing cause section should be further put in a separate category.  Oddly enough, the readers found a number of nursing home deaths, over 900, with CV-19 listed as the only cause on the certificate.  That simply cannot be right.  Nursing home residents almost universally have a number of serious illnesses.

Place of death is important to look at by age and by cause to understand trends related not only to CV-19 deaths but other deaths which might be related to lockdowns.  Minnesota has excess deaths due to things like dementia, diabetes, and other diseases, which reflect failure to get adequate care during the epidemic.  One way to see this is that among non-CV-19 deaths in 2020, deaths in nursing homes, hospice and hospitals declined by 1404 compared to 2019, while at-home deaths rose by 2804.  At lot of those at-home deaths were people afraid to go the ER or to seek care when they had heart attack symptoms, or low blood sugar issues, or signs of stroke.

To really understand what has happened, we need a full chart review of all deaths supposedly caused by CV-19 to see how many the experts think were actually due to the disease.  And we need full disclosure of all deaths by age, by cause, and by place of death, so the public can see the various trends and understand the effect of the response to the epidemic.