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“They were destined to die regardless.” Recently, a debate has surfaced on social media, suggesting that fatalities among individuals with pre-existing health issues who contract COVID-19 should not be classified as COVID-19 deaths. While it’s true that those with conditions such as heart disease, lung disease, and diabetes are at higher risk of severe outcomes, this raises concerns about how authorities attribute COVID-19 as the cause of death—especially when death rates influence decisions about reopening businesses and resuming normal activities.
“When autopsies are performed, the damage to the lungs is so distinct that it clearly differentiates COVID-19 from other conditions like coronary artery disease, emphysema, heart disease, or diabetes,” explains Dwayne Wolf, deputy chief medical examiner at the Harris County Institute for Forensic Sciences and a clinical assistant professor of pathology at Baylor College of Medicine. “COVID-19 stands as a unique and separate illness.”
The main cause of death is what ultimately led to the patient’s passing on that specific day
When establishing the cause of death, it involves identifying both the primary and contributing factors. For COVID-19 fatalities, the primary cause is frequently diffuse alveolar damage in the lungs, which results in respiratory failure and ultimately death.
If COVID-19 directly led to a person’s death on a specific day, it is classified as the primary cause—regardless of whether the death occurred a month or decades earlier than it might have under different circumstances.
Alongside the primary cause, death certificates include contributing factors like heart disease, diabetes, or other conditions that may have exacerbated the patient’s health. These factors, while not directly causing death, played a role in worsening the individual’s condition.
In simple terms, COVID-19 would not be listed as the cause of death if someone with a mild case died in a car accident, as the disease would not be responsible for their death on that day.
“There will always be instances where individuals die with COVID-19 but not because of COVID-19,” Wolf explains.
The methodology for determining cause of death remains unchanged
It’s crucial to note that the process of identifying the cause of death for COVID-19 patients aligns with standard medical practices used in other situations. As Wolf emphasizes, even under normal circumstances, causes of death are determined using patient history and statistical data.
“The process we follow now is identical to what we used before the pandemic and will continue to use afterward,” Wolf states.
Wolf’s Houston office has conducted numerous autopsies to ascertain whether deaths were linked to COVID-19. Their approach to determining the cause of death remains consistent with longstanding practices.
States differ in their methods for counting fatalities—some include probable COVID-19 cases where diagnostic tests were not conducted but symptoms and exposure align with the disease. Others have identified more cases where patients died with COVID-19 rather than from it. Despite these complexities, the underlying process and reasoning for determining cause of death remain consistent with standard procedures. Ultimately, establishing the cause of death is always a challenging task.
It’s likely that we are underestimating the total number of fatalities
Due to limited testing availability, many COVID-19-related deaths may have gone unreported. A recent New York Times analysis compared this year’s mortality rates with those from the same period last year. By analyzing the disparity in death rates and incorporating confirmed COVID-19 cases, they projected the potential number of unrecorded deaths.
This analysis suggests approximately 40,000 unaccounted deaths across 12 countries, including Belgium, France, Spain, and Switzerland. For New York City alone, an estimated 4,200 additional COVID-19 deaths may have occurred between March 11 and April 25.
In practical terms, this indicates a probable undercount of COVID-19 deaths, even though the process for determining cause of death remains unchanged. This data could play a crucial role in shaping future decisions and strategies.
