The Centers for Disease Control and Prevention's guidelines for listing COVID-19 on death certificates in the absence of a test are resulting in a case overcount.
In April 2020, Dr. Scott Jensen, a Minnesota physician who serves in the Minnesota state Senate, gave television interviews in which he suggested that guidance issued by the Centers for Disease Control and Prevention (CDC) to health care providers on how to properly fill out death certificates for COVID-19 cases could artificially inflate the number of such cases in the U.S.
“The determination of the cause of death is a big deal. It has impact on estate planning, it has impact on future generations,” Jensen told host Laura Ingraham. “The idea that we’re going to allow people to massage and game the numbers is a real issue because we’re going to undermine the [public’s] trust.”
On April 3, 2020, the CDC’s National Center for Health Statistics issued guidance to physicians, coroners, and medical examiners who fill out death certificates to list COVID-19 as an underlying cause of death in the absence of a test “if the circumstances are compelling within a reasonable degree of certainty.”
The guidelines specify:
In cases where a definite diagnosis of COVID–19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID–19 on a death certificate as ‘probable’ or ‘presumed.’ In these instances, certifiers should use their best clinical judgement in determining if a COVID–19 infection was likely. However, please note that testing for COVID–19 should be conducted whenever possible.
Jensen’s commentary contributed to a narrative promoted by right-leaning media outlets that the ongoing COVID-19 coronavirus disease pandemic is not as deadly or serious as reported, and that social-distancing measures implemented to control its spread are unwarranted. “HUGE! MN Senator and Dr. Reveals HHS Document Coaching Him on How to Overcount COVID-19 Cases,” read one headline from the conspiracy site The Gateway Pundit.
Experts, however, agree that COVID-19 cases in the U.S. are being undercounted, not overcounted, due to the lack of available diagnostic tests.
“I don’t think in any case are we over-estimating the deaths due to COVID-19. I think most likely we’re underestimating and in some cases we may be underestimating by a lot,” Bob Anderson, who heads the mortality statistics branch at the CDC’s National Center for Health Statistics, told us by phone. Anderson noted that medical examiners’ offices in the hard-hit state of New York are overwhelmed, and that the state has had an increase in unattended deaths in which COVID-19 was a likely factor, but no tests were available to confirm.
“We’re not asking [health care providers] to write [COVID-19] down for everyone who was possibly exposed. We’re asking only if the patient showed symptoms, and they’re reasonably certain” the patient had the disease, Anderson told us. “When the evidence tells you that COVID-19 was the likely cause of death then you should report it as the likely cause of death, whether you have a lab test or not. And medical examiners, physicians, and coroners are trained to make these determinations.”
As of this writing, the U.S. had more than 700,000 COVID-19 cases, with the death count nearing 40,000. Our attempts to reach Scott Jensen for comment were unsuccessful.