Thoughts on economics and liberty

COVID-19 deaths are counted DIFFERENTLY to deaths from other causes: THIS IS A SERIOUS MISDEMENOUR.

Even while writing the ICC complaint I wasn’t aware of this fact – that on 24 March 2020 CDC changed the method for counting deaths ONLY from covid. All other deaths are counted using the old (2003) method. THIS PANDEMIC IS TURNING OUT BE A SINISTER AND CRIMINAL ENTERPRISE.

 

HERE’S AN EXTRACT FROM A 24 JULY 2020 ARTICLE:

Why Did the CDC Decide to Create Unique Reporting Rules for COVID-19 When Successful Reporting Rules Already Existed?

A double standard exists for how COVID-19 data is collected and reported versus all other infectious diseases and causes of death. Let’s examine three essential data categories; Fatalities, Cases & Hospitalizations for all infectious diseases because there are significant flaws in what constitutes a COVID-19 case, hospitalization and fatality.

On March 24th, the CDC decided to ignore universal data collection and reporting guidelines for fatalities in favor of adopting new guidelines unique to COVID-19. The guidelines the CDC decided against using have been used successfully since 2003.

After all, based upon the July 11th data from the CDC’s Provisional COVID-19 Death Counts by Sex, Age & State webpage, if COVID-19 is an epidemic (122,374 Fatalities), then shouldn’t pneumonia (131,372 Fatalities) also be an epidemic?1

Fatality Data

It is important to note that COVID-19 data is collected and reported by a much different standard than all other infectious diseases and causes of death data. This unique standard for COVID-19 was used, despite the existence of guidelines that have been successfully used since 2003 for data collection across all infective, comorbid, and injurious situations.

… the rules for coding and selection of the underlying cause of death are expected to result in COVID19 being the underlying cause more often than not.

This begs the question, if the CDC already has well established guidelines for reporting fatalities then why make up new guidelines for COVID-19?

COVID-19 data is collected and reported based upon the March 24th National Vital Statistics Systems (NVSS) Guidelines and the April 14th CDC adoption of a position paper authored by the Council of State and Territorial Epidemiologists (CSTE). 8,9

However, the data for all other causes of death is based upon the 2003 CDC’s Medical Examiners’ & Coroners’ Handbook on Death Registration and Fetal Death Reporting and the CDC’s Physicians’ Handbook on Medical Certification of Death. 10,11

On March 24th, the NVSS, under the direction of the CDC and National Institute of Health (NIH), instructed physicians, medical examiners, and coroners that COVID-19 would:

  • be recorded as the underlying cause of death “more often than not;”
  • be recorded as the cause of death listed in Part I of the death certificate even in assumed cases;
  • be recorded as the primary cause of death even if the decedent had other chronic comorbidities. All comorbidities for COVID-19 would be listed now in Part II, rather than in Part I as they had been since 2003 for all other causes of death.

March 24th, 2020 – NVSS COVID-19 Alert No. 2

“Will COVID-19 be the underlying cause? The underlying cause depends upon what and where conditions are reported on the death certificate. However, the rules for coding and selection of the underlying cause of death are expected to result in COVID19 being the underlying cause more often than not.

“Should “COVID-19” be reported on the death certificate only with a confirmed test? COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death. Certifiers should include as much detail as possible based on their knowledge of the case, medical records, laboratory testing, etc. If the decedent had other chronic conditions such as COPD or asthma that may have also contributed, these conditions can be reported in Part II. (See attached Guidance for Certifying COVID-19 Deaths)”

It’s worth noting that Part I of a death certificate is the immediate cause of death listed in sequential order from the official cause on line item (a) to the underlying causes that contributed to death in descending order of importance on line item (d), while Part II is/are the significant conditions NOT relating to the underlying cause(s) in Part I.

As we will demonstrate shortly, comorbid conditions are always listed on Part I of death certificates as causes of death per the 2003 CDC Handbook, so that accurate reporting can be developed. Comorbidities are seldom placed in Part II, as this is typically the place where coroners and medical examiners can list recent infections as underlying factors.

Prior to the March 24th and April 14th decisions, any comorbidities would have been listed in Part I rather than Part II and initiating factors, like recent infections, would have been listed on the last line in Part I or in Part II.

Why does this matter?

This matters because the Part I causes of death are statistically recorded for public health reporting, while Part II does not hold nearly the same statistical significance in reporting. This March 24th NVSS guideline essentially allows COVID-19 to be the cause of death when the actual cause of death should be the comorbidity according to the industry-standard 2003 CDC Handbook. It can be a bit confusing, so we will present an example shortly for clarity.

On April 14th, the CDC in conjunctions with approval from the National Institute of Health (NIH), adopted the CSTE position paper that authorized the following guidelines for data collection and reporting which are completely unique for COVID-19 and had never been done before which:

  • allowed for ‘Probable’ cases, hospitalizations, and fatalities [section A5];
  • created a pathway for the minimum standards of evidence to be a single cough [section A1];
  • created a pathway for completely bypassing laboratory testing in order to classify a COVID-19 case as positive [section A5];
  • created a pathway for the minimum standard of evidence necessary for determining a COVID-19 case to be positive as being within 6 feet of a ‘Probable’ case for 10 minutes or traveling to an area with outbreaks [section A3];
  • declined to create any methodology for ensuring the same COVID-19 positive person would not be counted multiple times as a new case upon being tested multiple times [section B].

April 14th, 2020 – CDC Adopts CSTE Interim-20-ID-01

Title: Standardized surveillance case definition and national notification for 2019 novel coronavirus disease (COVID-19)

VII. Case Definition for Case Classification

  1. Narrative: Description of criteria to determine how a case should be classified.

A1. Clinical Criteria At least two of the following symptoms:

  • fever (measured or subjective), chills, rigors, myalgia, headache, sore throat, new olfactory and taste disorder(s) OR
  • At least one of the following symptoms: cough, shortness of breath, or difficulty breathing OR
  • Severe respiratory illness with at least one of the following:
    • Clinical or radiographic evidence of pneumonia, or
    • Acute respiratory distress syndrome (ARDS). AND
    • No alternative more likely diagnosis

A2. Laboratory Criteria Laboratory evidence using a method approved or authorized by the FDA or designated authority:

Confirmatory laboratory evidence:

  • Detection of SARS-CoV-2 RNA in a clinical specimen using a molecular amplification detection test

Presumptive laboratory evidence:

  • Detection of specific antigen in a clinical specimen
  • Detection of specific antibody in serum, plasma, or whole blood indicative of a new or recent infection*

*serologic methods for diagnosis are currently being defined

A3. Epidemiologic Linkage One or more of the following exposures in the 14 days before onset of symptoms:

  • Close contact** with a confirmed or probable case of COVID-19 disease; or
  • Close contact** with a person with:
    • clinically compatible illness AND
    • linkage to a confirmed case of COVID-19 disease.
  • Travel to or residence in an area with sustained, ongoing community transmission of SARS-CoV2.
  • Member of a risk cohort as defined by public health authorities during an outbreak.

**Close contact is defined as being within 6 feet for at least a period of 10 minutes to 30 minutes or more depending upon the exposure. In healthcare settings, this may be defined as exposures of greater than a few minutes or more. Data are insufficient to precisely define the duration of exposure that constitutes prolonged exposure and thus a close contact.

A4. Vital Records Criteria A death certificate that lists COVID-19 disease or SARS-CoV-2 as a cause of death or a significant condition contributing to death.

A5. Case Classifications

Confirmed:

  • Meets confirmatory laboratory evidence.

Probable:

  • Meets clinical criteria AND epidemiologic evidence with no confirmatory laboratory testing performed for COVID-19.
  • Meets presumptive laboratory evidence AND either clinical criteria OR epidemiologic evidence.
  • Meets vital records criteria with no confirmatory laboratory testing performed for COVID19.
  1. Criteria to distinguish a new case of this disease or condition from reports or notifications which should not be enumerated as a new case for surveillance
  • N/A until more virologic data are available

Additionally, the CSTE position paper gave no definition as to what constitutes a COVID-19 recovery for all state and country health departments to follow.

While the, seemingly independent, CSTE position paper was authored by five accomplished professionals from the Idaho, Alabama, Michigan, Hawaii, and Iowa state health departments; 5 of the 7 Subject Matter Experts who contributed to the position paper were directly employed by the CDC which raises ethical concerns about conflicts of interest.

It stands to reason that each of the professionals who contributed to the CSTE position paper were aware of the existence of the 2003 guidelines for reporting fatalities. Additionally, no subject matter experts from universities, medical examiners, coroners or private industry appear to have been consulted on the production of this highly questionable document.

 So, why does all of this matter?

It matters for several reasons:

  • The minimum standards defy accepted professional standards for differential diagnosis in medical practice;
  • Section A3 empowers contact tracers, who are unlikely to have any medical training, to illegally diagnose patients without even examining them, which is a violation of medical law in every state and constitutes practicing medicine without a license;
  • The CSTE position paper opens the door for any fatality to be listed as COVID-19 without any reasonable standard of evidence, while mandating that comorbidities simultaneously be deemphasized and moved to Part II, so as not to appear as a cause of death;
  • Simultaneous testing for all other infectious diseases, with similar respiratory symptom profiles like Coccidioidomycosis for Valley Fever, is not required. We therefore have no clinical or statistical means of knowing if a co-infection was present along with a positive finding of the SARS-CoV-2 virus in the differential diagnosis process.

Why was all of this necessary with a successful methodology for physicians, medical examiners, and coroners already in place since 2003?

The CDC’s 2003 Handbook suggests that COVID-19 should be listed either at the bottom of Part I or in Part II of a death certificate, rather than as the top line item in Part I, despite Dr. Fauci’s describing in multiple press interviews, that medical examiners and coroners would not be doing this, which disregards any knowledge of the March 24th orders by the NVSS to do so.

The ability for medical examiners and coroners to register their best medical opinion was neutered by the March 24th NVSS guidelines.

Let’s review what would have happened had the CDC decided to use their 2003 Handbook rather than adopting new rules for COVID-19 reporting.

2003 – CDC Medical Examiners’ and Coroners’ Handbook on Death Registration

“Because statistical data derived from death certificates can be no more accurate than the information provided on the certificate, it is very important that all persons concerned with the registration of deaths strive not only for complete registration, but also for accuracy and promptness in reporting these events.”.

“The principal responsibility of the medical examiner or coroner in death registration is to complete the medical part of the death certificate.”

“The cause-of-death section consists of two parts. Part I is for reporting a chain of events leading directly to death, with the immediate cause of death (the final disease, injury, or complication directly causing death) online (a) and the underlying cause of death (the disease or injury that initiated the chain of events [SARS-CoV-2 in this case] that led directly and inevitably to death) on the lowest used line. Part II is for reporting all other significant diseases, conditions, or injuries that contributed to death but which did not result in the underlying cause of death given in Part I.”

Under these guidelines, the highest COVID-19 could be listed in the presence of an established comorbidity would be Part I, line item (d) or lower, or in Part II.

 

The cause-of-death information should be the medical examiner’s or coroner’s best medical OPINION. Report each disease, abnormality, in-jury, or poisoning that the medical examiner or coroner believe adversely affected the decedent.”

The ability for medical examiners and coroners to register their best medical opinion was neutered by the March 24th NVSS guidelines.

If an organ system failure (such as congestive heart failure, hepatic failure, renal failure, or respiratory failure) is listed as a cause of death, always report its etiology on the line(s) beneath it (for example, renal failure due to Type I diabetes mellitus or renal failure due to ethylene glycol poisoning).”

Based upon the 2003 CDC Handbook, Part I for COVID-19 fatalities should contain any comorbidities first. Under these guidelines, COVID-19 would only be listed as a cause of death in Part I if there were no comorbidities and therefore the fatality counts for COVID-19 would be much lower than they currently are.

Here is the comorbidity data we have compiled from the only 7 states currently publishing this data in a manner that can be analyzed statistically. Note that 90.2% of fatalities had at least 1 comorbidity and therefore these fatalities would not be counted as COVID-19 fatalities under the 2003 CDC Handbook, but instead are counted based upon the NVSS guidelines and CSTE position paper adopted by the CDC on March 24th and April 14th respectively.

 

Keep in mind that while the number of fatalities with published comorbidity data is significant (N=44,562), we were unable to obtain comorbidity information on all fatalities from all states because the majority of states have not been publishing this data, if they are collecting it at all.

If each state were publishing comorbidity data, and if each state used the CDC’s 2003 Revision Handbook as they do for all other death certificates, the actual COVID-19 fatality totals would be approximately 90.2% LOWER than they currently are based upon an extrapolation of the data that is available.

2003 – CDC Medical Examiners’ and Coroners’ Handbook on Death Registration [continued]

“Only one cause is to be entered on each line of Part I. Additional lines should be added between the printed lines when necessary. For each cause, indicate in the space provided the approximate interval between the date of onset (not necessarily the date of diagnosis) and the date of death. For clarity, do not use parenthetical statements and abbreviations when reporting the cause of death. The underlying cause of death should be entered on the LOWEST LINE USED IN PART I. The underlying cause of death is the disease or injury that started the sequence of events leading directly to death or the circumstances of the accident or violence that produced the fatal injury. In the case of a violent death, the form of external violence or accident is antecedent to an injury entered, although the two events may be almost simultaneous.”

These clear guidelines from the CDC’s 2003 Handbook state that the highest COVID-19 would be able to be placed for comorbid conditions is on the lowest line in Part I without the March 24th NVSS guidelines and April 14th CSTE position paper. This means that while the SARS-CoV-2 virus may have initiated the process of death, the cause was actually the comorbidity as it should always be.

Additionally…

Without the March 24th NVSS guidelines or the April 14th CSTE position paper adoption, COVID-19 would NOT be allowed to be listed on a death certificate at all WITHOUT A POSITIVE LAB TEST or confirmatory pathologic autopsy findings.

Let’s take a look at how different the cause of death reporting can be for similar situations.

If we have a person who died from renal failure due to type 1 diabetes mellitus, but in scenario 1 the initiating factor was the H1N1 influenza virus while in scenario 2 the initiating factor was the SARS-CoV-2 virus, how would that look?

Here are 2 visuals of just how different these 2 very similar situations are to be recorded based upon March 24th NVSS guidelines.

Scenario 1 – H1N1 Influenza as Initiating Factor

 

Scenario 2 – COVID-19 as Initiating Factor

 

As you can see, these similar situations are reported dramatically different. As a result, the statistical reporting for fatalities will be dramatically different as well, for all people with known comorbidities, which makes up approximately 90.2% of all reported fatalities due to COVID-19 according to the US State Health Departments reporting this data.

 Why is all of this important?

The CDC knew in early March that the vast majority of fatalities would be in people over 60 with comorbidities according to Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases and reported by CNBC on March 9th, 2020.6

“This seems to be a disease that affects adults and most seriously older adults. Starting at age 60, there is an increasing risk of disease and the risk increases with age. People with diabetes, heart disease, lung disease and other serious underlying conditions are more likely to develop “serious outcomes, including death.”

Why would the CDC adopt new rules for reporting fatalities when they already had successful guidelines?

Was the CDC and Dr. Fauci, the head of the NIAID (a division of the NIH), aware of the potential implications that adopting these guidelines would create in terms of fatality reporting?

And perhaps the most important question of them all… Is SARS-CoV-2 a naturally evolved microorganism or is it the result of gain of function experiments?

These are questions Americans deserve answers to, for hopefully obvious reasons.

 

 

 

 

 

Sanjeev Sabhlok

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