As Minnesota’s death tolls surged in May, the words of a prominent Twin Cities funeral director were ringing in my ears: “What useful purpose is being served to record loved ones that died with COVID-19, not from COVID-19?” He concluded the interview by counseling: “Tony, get the total Minnesota mortality numbers for April and May and verify if the growth justifies the scale of the public emergency.”
Well, that was easier said than a done. First a voicemail to the Minnesota Department of Health (MDH) and then an email a week later — went unanswered. Finally, an email to Director of Infectious Disease Epidemiology, Kris Ehresmann and a reply that yes, her team would help me get the influenza, COVID-19 and state total death counts. And then as the task was handed down — another snag. MDH Media Relations stated that “we don’t do custom reports like that, but you can purchase the full death statistics table for $20 and sort it yourself.”
Biting my tongue, I fired back my credit card information and the hunt was on! Wondering out loud: How would a senior statesman like Sid Hartman, research such a 25 MB, text- delimited zip file?
I never made it to the flu/influenza numbers because the State’s COVID-19 death counts for April and May stopped me in my tracks. They are inflated. Even drawing in deaths that were listed as “probable COVID-19”, “test pending”, “complications of COVID-19” or anything that said COVID-19, I found 283 COVID cause-of-deaths in April. (The specific CDC term is underlying cause of death.) Ehresmann and her team sent me a table showing 343 official deaths. May was even more pronounced. The State MDH dashboard displays 696 deaths while I counted 542. In other words, April was miscounted by 17.4% and May by 22.1%.
When I interviewed Dan McGraw, President Gill Brothers Funeral and Cremation (and other funeral directors) in April, they related picking up decedents who were in hospice for cancer or other terminal illness and then being surprised to see that the cause of death was listed as COVID-19. When I dug into the detailed records from April and May, those anecdotes quickly morphed into hard facts.
The vast majority of the inflated COVID deaths: 60 in April and 87 in May had been entered with a different intent by the medical examiner or attending physician that completed the death certificate. Those professionals felt that the patient passed away from lung cancer, congenital heart disease, COPD, dementia, Parkinson’s or the like.
Here is a sample Cause of Death certificate displaying how a medical examiner determined the underlying cause of death as Diabetes Mellitus. Per the CDC and industry regulations, the condition on the last line — is the official cause of death. So in other words, when I scoured the data, I found scores of records like this with COVID-19 in one of the top lines while the certifier concluded the reportable cause of death in line b, c or d with a different disease. The certifier believed the underlying cause of death was not COVID-19.
So what happened? It would be easy to jump to the conclusion that the Minnesota Department of Health played a role. After all, they were under tremendous fire for our extended stay at home order and the dubious death model crafted by our own University of Minnesota. Well after a lot of digging, I found that once the death certificate is entered into the Minnesota Registration and Certification system, it is sent to an arm of the CDC — the National Health Statistics Center (NHSC) in Maryland. Their team then codes the death certificate and according to their web-site if COVID-19 is listed as a cause of death “anywhere on the death certificate”, the key Underlying Cause of Death becomes COVID-19!
When I contacted the National Health Statistics Center media team, they stated that not all COVID-19 mentions on the death certificate are labelled as the underlying cause of death — but 94 percent are.
So while countries such as Sweden record many decedents as passing with COVID-19, not caused by COVID-19, the U.S. government for some reason, is meticulously juicing our death counts. And the Minnesota Department of Health reporting system plays a role as well. Of the 152 inflated deaths in May, 67 were over reported at the MDH dashboard (health.state.mn.us). That count is important because that dashboard is the key source for media reporting.
And is this trend to over count COVID deaths continuing? Yes. I drilled down into the individual records in June and the NHSC and MDH continue the same procedures. The MDH dashboard displays 402 June COVID-19 deaths: 31 miscoded by the CDC and another 129 on the MDH site which in my calculation will not appear on the official COVID-19 death tally. It is important to note that the MDH dashboard is a complex database gathering immediate, probable COVID-19 data from hospitals, clinics and long-term care facilities across the state. MDH states that their data changes because non-Minnesota residents are pulled from the numbers, the COVID-19 status changes after an autopsy or lag in finalizing the death certificate.
That doesn’t take away from the impact of the analysis. If I remove the cancers, dementia, COPD, heart disease and other non-COVID underlying causes of death, the results are dramatic. My analysis came up 374 deaths below the State’s reporting number through June 30 — or 26 percent.
On May 20th KSTP’s Tom Hauser reported that: “the Governor says the U of M model is holding true to form with a surge still coming.” Hauser noted in Twitter that the Minnesota model had been revised from 74,000 to 55,000 to 29,000 deaths (at that time) and was 1000 short of the predicted May benchmark. My work showed the projection was a heckuva lot shorter than that!
Don’t get me wrong. I am in no way diminishing the tragedy of the pandemic. It has touched me and will likely affect every family in the state. I simply listened to funeral directors in the trenches that were recovering COVID-19 decedents that did not make sense. The deaths appeared to result from long-term illnesses and they wanted answers. Those answers may be complicated. On the one hand the Minnesota stay at home policies were extremely effective in saving lives — while the inflated COVID-19 death numbers certainly supported those restrictions.
In the end, I felt a bit better about my journey back to April and May when I came upon a quote from Baltasar Gracian:
Truth always lags last, limping along on the arm of Time.