SciCheck Digest
Viral social media posts cite a flawed paper in falsely claiming the Centers for Disease Control and Prevention changed death certificate procedures and violated federal law, resulting in wildly inflated COVID-19 deaths. The CDC hasn’t altered how death certificates for COVID-19 are filled out, and there is no federal law governing the process.
Full Story
A conservative talk radio host recently told her listeners that because of a change in death certificate procedures specific to COVID-19, “there is a huge chance that COVID death numbers are exaggerated, to the tune of 94%.”
That’s false. It’s based on a flawed report whose authors also have penned related claims for an anti-vaccination organization.
Wendy Bell, the radio host, made the claim in a March 25 episode of her Pennsylvania-based show. The show was streamed live on Facebook in a video titled, “Has the CDC skewed Covid Fatalities?” It has been viewed more than 34,000 times.
“I’ve reported multiple times that the CDC has said in its own little asterisk, bottom footnote: Of all deaths reported by coroners and health departments to the CDC, only 6% list COVID as the cause of death,” Bell says about 41 minutes into her video. “COVID is what killed this individual — not the tree that they ran into that killed them from blunt force trauma or whatever, and then they got tested in the morgue, but COVID. That 6% number is very significant, and now the CDC is walking it back.”
We’re not sure what she means by the “CDC is walking it back.” The Centers for Disease Control and Prevention website still makes note of the statistic that she’s referencing. But the statistic doesn’t mean, as Bell implies, that COVID-19 didn’t actually cause the other deaths.
We addressed similar social media posts in September that misrepresented CDC data on COVID-19 deaths. As we wrote, CDC data showed COVID-19 was the only cause mentioned on 6% of death certificates, while the other 94% of deaths included other illnesses or conditions, or comorbidities.
That’s not unusual since COVID-19 often causes other serious conditions, such as pneumonia or acute respiratory distress syndrome — which rank among the most-cited comorbidities for deaths involving COVID-19. Long-term conditions that increase the risk for severe COVID-19, such as diabetes or hypertension, are also among the comorbidities listed on death certificates.
The CDC notes, however, that 91% of all death certificates mentioning COVID-19 listed it as the underlying cause of death — or the condition that started the chain of events that led to a person’s death.
Report’s Origins
Now, Bell repeats the distortion about the 6% statistic and cites a paper that erroneously suggests the data is inflated because the CDC changed how such deaths are counted, and falsely claims it violated federal law.
Reading from a March 19 story in the conservative outlet the Epoch Times, Bell tells her listeners: “A little-noticed peer-reviewed study published last October by a science and public health journal claims the Centers for Disease Control and Prevention ignored federal laws and regulations when it changed how the government counts deaths from COVID-19, caused by the Wuhan virus.”
The paper referenced appeared in a publication called Science, Public Health Policy, and The Law. The publication started in 2019 and is the product of the Institute for Pure and Applied Knowledge, an organization run by James Lyons-Weiler. Lyons-Weiler is a scientist with a Ph.D. in ecology, evolution, and conservation biology from the University of Nevada, Reno, who has previously spread false information about COVID-19 vaccines.
Most of the paper’s authors also wrote a related post, cited in the report, for Children’s Health Defense, an organization run by anti-vaccine activist Robert F. Kennedy Jr., son of the former U.S. Attorney General Robert F. Kennedy and nephew of former President John F. Kennedy.
We reached out to the report’s lead author, Henry Ealy, a naturopathic doctor based in Oregon, with some questions about its main points and didn’t receive an on-the-record response.
In addition to Bell and the Epoch Times, the paper’s claims have been amplified by other conservative outlets. A February story on the website the National File — headlined “BUSTED: CDC Inflated COVID Numbers, Accused of Violating Federal Law” — was shared more than 16,000 times on Facebook, according to CrowdTangle analytics data.
Guidance Didn’t Violate Federal Law
The paper’s authors say that, “[b]ased upon our investigation of Federal Register Records for 2020, there was no formal, transparent, public review process initiated by the NVSS or CDC prior to or following the issuance of the March 24th NVSS COVID-19 Alert No. 2 that dramatically altered cause of death reporting exclusively for COVID-19.”
The March 24, 2020, alert being referenced came from the National Vital Statistics System, part of the CDC’s National Center for Health Statistics. It notified the public of a new International Classifications of Diseases code for COVID-19 — since the disease was new, there was no previous code — and offered brief guidance on using it.
Days after the March 24 alert, the CDC issued April 2, 2020, guidance explaining more thoroughly how COVID-19 death certificates should be completed. (The agency has issued similar death reporting guidance for other issues, such as for fatalities due to drug toxicity and relating to disaster events.)
In short, the paper’s authors argue that the March 24 notice was subject to the Information Quality Act and Paperwork Reduction Act — and therefore should have been publicized in the Federal Register and subject to public comment.
But there’s no support for that claim.
First of all, we should note that there is no federal law governing death certificate processes.
Robert Anderson, chief of the mortality statistics branch at the CDC’s National Center for Health Statistics, told us in an email that “the collection of death certificate data is not covered by the [Paperwork Reduction Act],” as the paper suggests.
“Death certificate data is collected by the states (i.e., 57 jurisdictions, including 50 states, New York City, District of Columbia and 5 territories), according to state laws and regulations, not according to federal laws or regulations,” he said. “While CDC, i.e., the National Center for Health Statistics, does work with the states to coordinate and promote standardized data collection, along with guidance on some issues such as cause of death certification, NCHS does not (and cannot) impose any legal requirements.”
Anderson said that states develop laws and regulations with the standards in mind, and “[o]nce the data are collected by the states, NCHS purchases the data from the states in order to provide national statistics.”
Bridget Dooling, a research professor at the Regulatory Studies Center at George Washington University, said that since the collection of death certificate data isn’t subject to the Paperwork Reduction Act, the CDC’s March 24 guidance wouldn’t be, either.
Dooling — who worked at the Office of Information and Regulatory Affairs, within the White House Office of Management and Budget, from 2007 to 2018 — also said in a phone interview that the guidance wouldn’t be subject to the Information Quality Act, since those provisions relate to the ways in which government disseminates information.
Public health legal experts similarly told our fact-checking colleagues at AFP that the CDC’s guidance didn’t violate federal law.
Baseless Claim of Reporting Change
In addition to the claim about the legality of the CDC’s COVID-19 death reporting guidance, the paper’s main contention is that the guidance was a stark departure from the CDC’s guidelines used since 2003. It baselessly suggests that, using the 2003 guidance, COVID-19 fatalities would “be approximately 16.7 times lower than is currently being reported.”
“If the fatality data being presented by the CDC is illegally inflated, then all public health policies based upon them would be immediately null and void,” the authors wrote.
But the paper misconstrues how death certificates are completed, experts say, and wrongly concludes that a massive change occurred.
“The death certification process has not been changed by the CDC,” Dr. James Gill, president of the National Association of Medical Examiners, told us in an email. “I still fill out death certificates the way I have been doing it for over 20 years.”
Gill, the chief medical examiner in Connecticut, pointed out that the paper illustrates a misunderstanding of how death certificates are completed.
For example, the paper says that Part I of the death certificate “is the immediate cause of death listed in sequential order from the official cause on line item (a) to the underlying causes that contributed to death in descending order of importance on line item (d).”
But it’s the most important diagnosis — the underlying cause of death — that is to be listed on the lowest line of Part I, Gill said. The condition immediately preceding death (such as pneumonia) would be listed first and then the illness that caused that condition (COVID-19, for example) would be listed below it.
Similarly, Anderson, the chief of the CDC’s mortality statistics branch, said the “authors of the October paper do not seem to understand how death certificates are designed or how the cause of death should be certified.”
A comparison of the 2003 guidelines and the COVID-19 guidance doesn’t reveal any significant change in procedure.
“Part I is for reporting a chain of events leading directly to death, with the immediate cause of death (the final disease, injury, or complication directly causing death) on line (a) and the underlying cause of death (the disease or injury that initiated the chain of events that led directly and inevitably to death) on the lowest used line,” the 2003 guidelines say. “Part II is for reporting all other significant diseases, conditions, or injuries that contributed to death but which did not result in the underlying cause of death given in Part I.”
And here’s how the CDC explained the completion of death certificates in its April 2020 guidance specific to COVID-19, beginning with Part I:
CDC, “Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID–19),” April 2, 2020: This section on the death certificate is for reporting the sequence of conditions that led directly to death. The immediate cause of death, which is the disease or condition that directly preceded death and is not necessarily the underlying cause of death (UCOD), should be reported on line a. The conditions that led to the immediate cause of death should be reported in a logical sequence in terms of time and etiology below it. The UCOD, which is “(a) the disease or injury which initiated the train of morbid events leading directly to death or (b) the circumstances of the accident or violence which produced the fatal injury” (7), should be reported on the lowest line used in Part I. … Other significant conditions that contributed to the death, but are not a part of the sequence in Part I, should be reported in Part II. Not all conditions present at the time of death have to be reported—only those conditions that actually contributed to death.
So it’s not accurate to claim that the CDC’s COVID-19 guidance represented a significant departure from the 2003 guidelines, as the paper repeatedly says.
It’s unclear why the authors conclude that, under the 2003 guidelines, COVID-19 would have been “more correctly” included “in Part II as an infection that contributed to death.”
The authors also say that the “inclusion of probable fatalities” is indicative that the “data presented is inaccurate.”
But the 2003 document, in fact, notes that the cause of death is to be determined according to the best medical opinion — and clearly states: “A condition can be listed as ‘probable’ even if it has not been definitively diagnosed.”
And contrary to Bell’s insinuation that fatalities are being deliberately inflated by deaths unrelated to the disease — such as “the tree that they ran into that killed them from blunt force trauma or whatever” — the CDC explicitly advises that COVID-19 not be reported in such cases where the disease didn’t factor into the death.
The CDC emphasizes: “COVID-19 should not be reported on the death certificate if it did not cause or contribute to the death.”
Finally, the paper makes no mention of excess deaths. As we’ve previously explained, excess deaths are deaths above the number expected in a given time period. In the context of COVID-19, it can help assess the true impact of the pandemic by capturing direct and indirect effects of the virus. It can account for unreported COVID-19 deaths and for other factors, such as people dying from other causes (say, avoiding medical attention), as well as drops in other deaths due to pandemic-related restrictions.
A New York Times analysis of CDC mortality data shows that, from March 2020 to February 2021, deaths nationwide were about 21% higher than what would have been expected during that time period.
Editor’s note: SciCheck’s COVID-19/Vaccination Project is made possible by a grant from the Robert Wood Johnson Foundation. The foundation has no control over our editorial decisions, and the views expressed in our articles do not necessarily reflect the views of the foundation. The goal of the project is to increase exposure to accurate information about COVID-19 and vaccines, while decreasing the impact of misinformation.
Sources
Anderson, Robert. Chief of mortality statistics branch, National Center for Health Statistics, Centers for Disease Control and Prevention. Email to FactCheck.org. 1 Apr 2021.
Dooling, Bridget. Research professor, Regulatory Studies Center, George Washington University. Phone interview with FactCheck.org. 31 Mar 2021.
Gill, James. President, National Association of Medical Examiners. Email to FactCheck.org. 31 Mar 2021.
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