The state’s most prominent medical examiner thinks death counts are too high when evidence suggests we’re underestimating the real toll.
It is a scientific fact that more than 225,000 Americans and 1,800 Wisconsinites have died from COVID-19, but a widespread conspiracy proliferated largely through social media by President Donald Trump and conservative news figures like right-wing talk-radio host Mark Levin falsely claims the death count is inflated, despite concrete statistics from some of the world’s top health organizations like the Centers for Disease Control and Prevention and Johns Hopkins University.
And Wisconsin officials from Sen. Van Wanggaard, R-Racine, to Milwaukee County Medical Examiner Dr. Brian Peterson bought into that lie weeks before Trump suggested in a Waukesha rally that deaths are overreported.
“I’m not exactly sure where it’s coming from and I don’t understand why this is perpetuated,” Bob Anderson, head of the mortality statistics branch of the Centers for Disease Control and Prevention’s National Center for Health Statistics, told UpNorthNews.
The conspiracy appears to have begun when the CDC published a report at the end of August that said COVID-19 was the sole listed cause of death for 6% of people who have died of the virus. On a death certificate, medical examiners list the underlying cause of death and any contributing factors, or comorbidities.
The CDC report noted 94% of people whose death was attributed to the virus had other factors such as underlying medical conditions that contributed to their death or were inflamed by the coronavirus. That number now stands at 92%, Anderson said, indicating COVID-only deaths have increased.
But that does not mean 92% of deaths are misclassified, Anderson said; it simply confirms what was already known: COVID-19 kills people with chronic health problems far more easily and frequently than those without.
For instance, Anderson said, someone with a chronic heart condition may directly die of cardiac arrest, but a medical examiner should still include COVID-19 on the death certificate if they feel the virus inflamed the condition. Although COVID-19 may not have been the underlying cause, it should still be considered a COVID-19 death because the person’s chronic condition would not have killed them without the virus’ help, Anderson said.
That discrepancy led to misleading reporting from the Milwaukee County Medical Examiner’s Office, which investigates deaths in Milwaukee, Jefferson, Kenosha, Racine and Ozaukee counties—the largest jurisdiction of any medical examiner’s officer in the state.
Milwaukee County’s “official” COVID-19 death count as of Tuesday morning was 472, according to local health data. The local count is about 100 lower than the state Department of Health Services, which as of Tuesday morning logged 571 COVID deaths in Milwaukee County.
Peterson, Milwaukee County’s chief medical examiner, contended his office’s count was correct because he is only counting deaths where coronavirus was listed as the primary cause of death—not when it is listed as a comorbidity on the death certificate.
“It comes down to a fundamental difference, in my view, from dying of something versus dying with something,” Peterson told UpNorthNews Tuesday morning. Peterson first spoke out about his belief that the state is reporting too many deaths in Milwaukee County in a late September interview with WISN.
Because COVID-19 is one of various reportable diseases, any time a COVID case or death is recorded, a report is automatically sent to the state Department of Health Services. Any death certificate that lists COVID-19 as an underlying or contributing factor to death is included in the state’s death count.
“Every death that we report is a report of a clinician in a hospital or a medical examiner who has made a determination based on the clinical evidence that a person’s death was in part or mainly due to COVID-19,” said Dr. Ryan Westergaard, DHS’ chief medical officer, in a Tuesday call with reporters.
Anderson with the CDC said the state’s count was more accurate because comorbidities should not be listed on a death certificate unless they played a role in a person’s death.
“On a death certificate, only those conditions that caused or contributed in some way to death are supposed to be reported,” Anderson said. “You’re not supposed to report any incidental conditions on the death certificate.”
Still, Anderson said, it is worthwhile to transparently track both figures so the public and health experts can get a better idea of the virus’ effects.
“If I was working in the [DHS] and I had this disagreement with the medical examiner, I’d say, ‘Okay, all right, we’ll count it both ways,’” Anderson said. “And then people can decide what number to use. That way you’re getting the information out: This is the total impact of the virus on the population, and here’s the total number where it was the underlying cause.”
That being said, the CDC includes COVID-comorbidity deaths in its numbers. As of Tuesday morning, the official COVID-19 death count as reported by the CDC is 225,084.
However, that count is likely short of the true number of deaths.
Other deaths—perhaps undetected because they occurred before the country had widely available testing—show up in a statistic called excess deaths, or deaths above an average year. The US has experienced as many as 311,000 excess deaths since Feb. 1, less than two weeks after the virus reached the US, according to CDC statistics. That means nearly 90,000 more deaths could be attributed to COVID-19 than the CDC’s official count indicates.
“That can only be explained by the pandemic,” Anderson said. “There’s no other explanation for it.”
The CDC’s website says just 5% of its tracked excess deaths “potentially could be indirectly related to COVID-19.”
The conspiracy of an inflated death toll reached at least one Wisconsin lawmaker. In a recent interview with the Milwaukee Journal Sentinel, Wanggaard falsely insisted there is a “significant” inflation of death statistics but would not specify by how much he believed the numbers were inflated. Wanggaard could not be reached by UpNorthNews for comment.
To prove his point to the Journal Sentinel, Wanggaard cited anecdotal evidence that people who clearly died of other causes were sometimes counted as COVID deaths.
One such common example, which Wanggaard did not bring up, was a motorcyclist in Florida who died in a crash but was initially counted as a COVID death because he tested positive.
Peterson, the Milwaukee County Medical examiner, mentioned this case in his justification for the way he counts deaths.
“I don’t wanna be that guy,” he said. “The guy you hear about who said, ‘You know, they died in a motorcycle crash but they tested positive for COVID and maybe COVID caused the crash, so I’m going to call it a COVID death.’”
The motorcycle death was quickly removed from Florida’s official count upon investigation. Such is standard practice, Anderson said; statewide health departments may include deaths such as the motorcyclist’s until the case is further reviewed, but officials regularly revise death counts to exclude such cases following the official filing of death certificates.
In a campaign stop last weekend in Waukesha, Trump baselessly accused hospitals of inflating COVID death numbers because they receive more reimbursement from Medicare when they report a coronavirus death.
“If somebody’s terminally ill with cancer, and they have COVID, we report them,” Trump told the crowd. “And you know, doctors get more money and hospitals get more money. Think of this incentive.”
Peterson echoed Trump’s comments, suggesting the state and local hospitals may be overcounting COVID deaths for political or monetary gain.
“You get off in the weeds and you start wondering, is there money involved? Is there politics involved?” Peterson said. “Well, you and I both know these days politics and money are always involved, right? But I try to avoid that as much as possible in my work.”
It is true that healthcare providers get more money for treating uninsured coronavirus patients—a provision of the federal coronavirus relief package Trump signed into law—but there is no evidence of any hospital falsely reporting deaths for more money.
Asked whether he was directly accusing the state of such practices, Peterson conceded, “I have not had anybody come in the front door with a basket of money and say, ‘Hey, you know what? If you call those COVID deaths, this basket of money could be yours.’”