Only 17K deaths?

There is outrage going around. People feel like they’ve been lied to because there were “only 17K deaths due to only COVID-19” in England and Wales. Outrageous!

This article has a slightly different explanation on the 17K deaths number, and they are more likely to be correct than me. Go read that article and ignore what I wrote below.

My explanation, from what I had heard elsewhere, was this:

Except that it’s not exactly what it sounds like. What it really means is that COVID-19 was the only thing listed on the death certificate.

HOWEVER, it is normal to put the root cause of death on the death certificate and the ultimate cause. Having COVID-19 in your bloodstream isn’t inherently deadly, it’s not like cyanide. Many people have COVID-19 in their bloodstream and don’t die.

It’s when COVID-19 causes a blood clot and causes a stroke that you die. It’s when COVID-19 damages your lungs so badly that you can’t get enough oxygen that you die.

So it’s normal to put e.g. “COVID-19, stroke” or “COVID-19, respiratory failure” on the death certificate. This means that they can later look to see if different cohorts die of different things. Perhaps they will find out that for women between 40 and 50 years old, COVID-19 wrecks their kidneys, while for men between 40 and 50 years old, COVID-19 causes strokes. If you find that out, then you can adjust and watch the salt and potassium levels really closely for 40-50 y/o women, while you put 40-50 y/o men on blood thinners right away. (This is a “for-example”, not a description of what actually happens to 40-50 y/os.)

This means that if the death certificate just says, “COVID-19”, then it’s basically an error. Maybe they didn’t have time to do an autopsy, or the family didn’t want an autopsy — it might not be the doctor’s fault. Maybe there were multiple things which were going wrong, and the doctor didn’t know which one it was: did stroke or kidney failure or respiratory failure get them first?

People have also commented on how the average age of people who only had COVID-19 on their death certificate were quite old. That makes sense: when you are very old, all of your systems are frail. There also is less motivation to find an ultimate cause of death: if someone who is 105 dies, that’s not unusual, and an autopsy probably won’t give useful information. (When I asked my mom what grandmother’s cause of death was after her long hospital stay, Mom sighed and said, “She died of being old.”) If a 21 y/o dies, that’s unusual, and people want to find out why.

So the fact that only 17K people in England and Wales — mostly old people — died with only COVID-19 on the death certificate, is not a bad thing: it’s an indication that most of the death certificates were filled out well.

Addendum: I should also mention that if someone dies at 80 and the expected lifetime is 80, then that 80 year-old person’s expected time to live is still quite a few years. “Expected lifetime” includes all the people who died in childhood. According to this chart, if you make it to age 80, you probably have eight years (men) or ten years (women) left.