I’m continue where we left off with this World Health Organization document. We got the gist of it already:
Section 3, C is about Chain of Events
Specification of the causal sequence leading to death in Part 1 of the certificate is important. For example, in cases when COVID-19 causes pneumonia and fatal respiratory distress, both pneumonia and respiratory distress should be included, along with COVID-19, in Part 1. Certifiers should include as much detail as possible based on their knowledge of the case, as from medical records,or about laboratory testing.
Here, on the International Form of Medical Certificate of Cause of Death, is an example of how to certify this chain of events for deaths due to COVID-19 in Part 1
So, in the example, under the Cause of Death column, line a has the condition “directly leading to death” which is “Acute Respiratory Distress Syndrome” (2 days before death). Then line b below that is “Due to” and has “pneumonia” (onset 10 days prior to death) and line c below that is “Due to” and has “COVID-19 (test positive)” (onset at 14 days before death)
Just some questions. Why is it assumed that the presence of the virus indicates the cause of the pneumonia? What about other viruses being present? What about other factors that might cause pneumonia? I guess it’s just an assumption the doctor is going to make based on the media and government environment.
Then it says:
. . . Please remember to indicate whether the virus causing COVID-19 had been identified in the defunct [meaning in the deceased].
There is increasing evidence that people with existing chronic conditions or compromised immune systems due to disability are at higher risk of death due to COVID-19. Chronic conditions may be non-communicable diseases such as coronary artery disease, chronic obstructive pulmonary disease (COPD), and diabetes or disabilities. If the decedent [deceased] had existing chronic conditions, such as these, they should be reported in Part 2 of the medical certificate of cause of death
In the next example, a and b are the same, but c is has “Suspected COVID-19” so there is no lab test. And Part 2 “Other significant conditions contributing to death (time intervals can be included in brackets after the condition) . . .” has: Coronary artery disease [5 years], Type 2 diabetes [14 Years], Chronic obstructive pulmonary disease [8 years]
. . . COVID-19 cases may have comorbidity. The comorbidity is recorded in Part 2.
So, I don’t see why “Suspected COVID-19” is picked as the “underlying” cause of death in that case unless there were very specific symptoms to distinguish it from flu or even to determine that it was either flu or COVID-19. I just don’t see how anyone could avoid counting up large numbers of COVID-19 death certificates if the official documents are basically telling them to put COVID-19 or “Suspected COVID-19” as the underlying cause. Shouldn’t they justify it also with a symptom list? Wouldn’t doctors in previous years have listed “pneumonia” or “influenza” as the underlying cause sometimes–on the lowest line in part 1? Just different labels–especially if they don’t do a test. Now this year, they see what they’re told to expect. I’m just making observations and assessing this as a layperson. At the very least, all this information and these instructions from the WHO is going to skew the number of deaths labeled as COVID-19.
To me, it’s human behavior that I’m interested in dealing with–the decision making involved in filling out a form. Human psychology works a certain way under political and economic pressure–with peer pressure, “authority”, fear, repetition and propaganda. “I’m just doing my job.” People take the path of least resistance. We know how we are. If the human being–regardless of how intelligent they supposedly are–is reduced to just someone that **follows instructions**–so there is set output already decided for a particular input, then that really is what we could call “artificial” intelligence–or machine-like behavior. This is the point of past human experimentation with mind control and cybernetics.
I think that this is what we get when we have been domesticated with drugs and propaganda–and then most of us can be replaced with machine artificial intelligence because we don’t think for ourselves anyway and don’t go against orders. Another word for this is dictatorship. In a free society, it’s just corruption. I’m not condemning everyone. I’m just interpreting our situation. People want to survive, they want to pay their debts. But we have to decide where we draw the line and whether we really want to give up rights and freedoms—personal autonomy. Respect for rights and freedoms provides real security for ourselves and others
I did notice this over the last ten years (but it has been going on longer since the anti-smoking campaign era of Gro Brundtland) – that almost every year the WHO would issue instructions about their alarming disease epidemic stories (like Zika–alarming but was it true?). A lot of doubts and questions came up about most of these–but the public might never have heard the doubts–they just get the initial blast of announcements–which reached right down to the email boxes of corporate employees–as though we were being trained into accepting WHO’s authority and legitimacy–even though it isn’t elected. It’s a private group, for the most part funded by the Gates Foundation. We see it as legitimate because governments and media have made it seem that way.
The next example has “COVID-19” as the underlying cause and “cerebral palsy” in Part 2 as a comorbidity (a significant condition contributing to death).
So I could see how someone could question these examples if they were actual death certificates. It seems very arbitrary.
Then the next hypothetical death certificate is more complex. Respiratory failure due to Pneumonia due to “Pregnancy complicated by COVID-19.” I don’t know if real-life cases occurred like these. In a couple of these it doesn’t indicate they were “tested”–just says “COVID-19”. If pregnancy could be put in the last line in Part 1 as part of the underlying cause, then why couldn’t “cerebral palsy” be put there? I wouldn’t put it past a UN association to associate pregnancy with sickness and death.
In these examples, COVID-19 is always going in the most important line. I think someone who thought more holistically about medicine could think of putting “malnutrition” or “poor nutrition” as the underlying cause of getting sick from a virus–and I think that could become more evident since the economy has been damaged very badly.
The next example is where the WHO document is explicit about not listing COVID as a cause of death in the case of an automobile accident. The next example is heart failure due to myocardial infarction. In both examples, however, the doctor is allowed to list COVID-19 in Part 2, so it’s considered a possibility that it contributed to death.
The next section talks about coding for tablulation.
4. GUIDELINES FOR CODING COVID-19 FOR MORTALITY
So the current one is updated for COVID-19: ICD-10 Version:2019
This link points to:
U07.1 COVID-19, virus identified
Use this code when COVID-19 has been confirmed by laboratory testing irrespective of severity of clinical signs or symptoms. Use additional code, if desired, to identify pneumonia or other manifestations
Notice that the symptoms can be very mild and it is still called COVID-19.
This next one is COVID-19 diagnosis without any lab test result:
COVID-19, virus not identified
Use this code when COVID-19 is diagnosed clinically or epidemiologically but laboratory testing is inconclusive or not available. Use additional code, if desired, to identify pneumonia or other manifestations
This is about how to count up the COVID-19 deaths based on the death certificates.
Although both categories, U07.1 (COVID-19, virus identified) and U07.2 (COVID-19, virus not identified) are suitable for cause of death coding, it is recognized that in many countries detail as to the laboratory confirmation of COVID-19 will NOT be reported on the death certificate. In the absence of this detail, it is recommended, for mortality purposes only, to code COVID-19 provisionally to U07.1 unless it is stated as “probable” or “suspected”.
This seems very blatant to me. They don’t expect the laboratory confirmation to be on the death certificate in many countries anyway (I guess they’re assuming often there just won’t be any kind of test result), so therefore “COVID-19”–unless it is called “suspected” or “probable” is automatically put in U07.1 category–even though that is supposed to mean “confirmed by laboratory testing”!
In practical terms, this means there is no reason at all to assume that the number of deaths attributed to COVID-19 have been confirmed as tested in a laboratory.
But I think this is wrong to contradict your own terms and definitions. It’s just corruption. Why bother having U07.2?
The rest of this section remains just as flaky. Is that because “public health” attracts “means to an end” justifications for making things convenient for those enjoying power (another example being censorship).
The international rules and guideline for selecting the underlying cause of death for statistical tabulation apply when COVID-19 is reported on a death certificate but, given the intense public health requirements for data, COVID-19 is not considered as due to, or as an obvious consequence of, anything else in analogy to the coding rules applied for INFLUENZA. Further to this, there is no provision in the classification to link COVID-19 to other causes or modify its coding in any way.
With reference to section 4.2.3 of volume 2 of ICD-10, the purpose of mortality classification (coding) is to produce the most useful cause of death statistics possible. Thus, whether a sequence is listed as ‘rejected’ or ‘accepted’ may reflect interests of importance for public health rather than what is acceptable from a purely medical point of view. Therefore, always apply these instructions, whether they can be considered medically correct or not. Individual countries should not correct what is assumed to be an error, since changes at the national level will lead to data that are less comparable to data from other countries, and thus less useful for analysis.
I think it’s worth reading that a couple of times if you still think the numbers are so “scientific.”
A manual plausibility check is recommended for certificates where COVID-19 is reported, in particular for certificates where COVID-19 was reported but not selected as the underlying cause of death for statistical tabulation.
There are a couple of examples. It doesn’t matter how much information the doctor puts into Part 2 about comorbidities, since he was told to put COVID-19 as the “underlying cause”–bottom line in Part 1 and never above that, the cause of death is going to be counted as COVID (U07.1 or U07.2). The document says as I interpret it (as quoted above) to not link COVID-19 to underlying causes–and in the examples, it’s supposed to be an underlying cause (or in the case of an auto accident, it could be listed as a comorbidity in Part 2), but it is never shown as due to something else.
They give the following instruction in one example:
Code all entries in Part 1 and 2, and in this example select COVID-19 as underlying cause of death (the case probably has been tested positive).
It just says “COVID-19” but you’re supposed to think “probably” it was tested positive so you pick “U07.1” not “U07.2” as a coder.
OK, another example of interest to us is when the doctor/certifier puts “COVID-19” on the middle line below “Acute respiratory disease syndrome” and above HIV Disease.
The instructions are, in this case, “NO, NO, NO, that’s wrong”:
The certifier should have added the HIV diseaseas a comorbidity in Part 2 of the certificate, however the selection rules of ICD allow to identify COVID-19 as underlying cause of death. . . Mortality coding rule step SP4 applies as causes have been reported on more than one line in Part 1 and the condition reported first on the lowest used line (HIV disease) cannot cause all the conditions. [See ICD-10 2016 and later, Volume 2, Section 4.2.1].
Without getting into the specifics, it smells like a double bind where basically the doctor/certifier really would like to make HIV the underlying cause of death but he also feels like he is supposed to mention COVID-19 as a cause of death. And once that’s the case, he/she has to make it the underlying cause and they’re going to count it that way anway. I assume they mean that HIV doesn’t cause COVID-19 so it can’t be part of that sequence. So this document is just telling certifiers (and the coders) over and over to make COVID-19 the underlying cause.
E-Additional WHO cause of death certification links
•How to fill in a death certificate: Interactive Self Learning Tool (WHO) (http://apps.who.int/classifications/apps/icd/icd10training/ICD-10 DeathCertificate/html/index.html) [removed]
Examples of terms used by certifiers to describe COVID-19and that can be coded as synonyms of COVID-19:
Sars-Cov-2 Infection (Coronavirus Two Infection)
Infection –COVID-19 (Coroner Informed)
Hospital Acquired Pneumonia-COVID-Positive
Corona Virus two infection (SARS-Cov-2)
Corona Virus Pneumonia (COVID-19)
This link explains:
COVID-19 (novel COronaVIirus Disease-2019) is the disease, SARS-CoV-2 is the virus