Gideon M-K wrote an article recently on “The Most Persistent Myth About COVID-19”. It debunks the persistent myth, echoed by public health luminaries like RFK Jr., that people who died of COVID-19 mostly died of pre-existing chronic conditions, rather than the virus itself. This falsehood is encapsulated by the following quote from testimony RFK Jr. gave last month:
In fact, during COVID, we had the highest death rate of any country in the world. And when you ask CDC, why is that true? They say, well, it’s because we’re the sickest population. The average American who died from COVID had 3.8 chronic diseases. What was killing them? COVID or the chronic disease? You have to understand infectious disease has a very hard time killing a healthy person.
This is false, but it stems from a misunderstanding in how death reporting works. Consider the following passage from the CDC website on COVID-19 deaths:
For over 5% of these deaths, COVID-19 was the only cause mentioned on the death certificate. For deaths with conditions or causes in addition to COVID-19, on average, there were 4.0 additional conditions or causes per death.
Perusing the “Comorbidities and other conditions” table on that website will show you that many of the most common conditions listed on the death certificate alongside COVID-19 are downstream consequences of the disease, such as respiratory failure and pneumonia. But as M-K points out, CDC reporting does not distinguish between a condition contributing to death and a secondary underlying cause.
The table also does not reveal and especially sick subpopulation. Again from M-K:
Of these deaths, just under 15% had diabetes listed as a contributing issue. That’s only slightly higher than the US national diabetes prevalence, which is estimated at 12% (or around 15% of adults).
This is not to say that a healthier population would not be more resilient to severe outcomes from infectious diseases, including death. But it is not true that COVID-19 was a simple cull of the sickest among us, which has become the standard framing of the pandemic in some circles.
The important broader point is that it is always important to know what your numbers mean. To know what is actually being measured. Otherwise, we just end up talking past each other while using data as a rhetorical shillelagh rather than a way of illuminating our policy disagreements.