As of July 17, 2020 the Palm Beach County Medical Examiner’s Office reported a total of 580 deaths in the county, 79 fewer than the 659 reported by local media. But that’s not the only discrepancy.
Shockingly, 8 of the 580 patients had no Covid-19 complications at all listed as their cause of death or even a contributing cause of death. Those 8 patients died from events such as a gunshot wound to the head, hip fracture, congestive heart failure, or Parkinson’s disease yet all 8 patients were included on the list of Covid-19 deaths by the Palm Beach County Medical Examiner.
Another 78 cases have a primary cause of death that is not related to Covid-19. These patients only have a “contributory” cause of death listed as Covid-19. “Contributory” causes are those that did not directly cause the death of the patient. Those 78 patients had a direct cause of death such as congestive heart failure, kidney cancer, blunt head trauma, and metastatic pancreatic cancer and were also counted as Covid-19 deaths.
The Centers for Disease Control and Prevention document, Guidance for Certifying Deaths Due to Coronavirus Disease 2019, published in April 2020, provides official guidance to death certifiers on the proper way to report deaths on death certificates. The guidance specifies that a patient’s “cause of death” is “the conditions that led to the immediate cause of death” and that the cause should “be reported in a logical sequence” starting from the underlying cause of death and ending with the immediate cause of death.
A patient’s “contributory cause of death,” on the other hand, is an illness that contributes to a death, but is not a part of the sequence that led to the immediate cause of death, the CDC reports.
Despite this CDC guidance making a clear distinction between a patient’s cause of a death and a contributing cause, the CDC published a webinar that directs physicians and other death certifiers to mark both types of death as a Covid-19 death. The webinar, with the same title as the guidance document, states that a Covid-19 provisional death count “includes deaths with Covid-19 as the underlying cause or contributing cause.”
It is not clear why the webinar guidance gives the instructions to count patient deaths that were not caused by Covid-19 as a Covid-19 death or why the Palm Beach County Medical Examiner’s Office has marked deaths such as “blunt head trauma” as a Covid-19 death.
The CDC’s website defines “provisional data” as preliminary data that may not yet be complete.