Surgeon David Gorski writes:
It’s always weird to try to get blogging again after an absence due to a health issue with a member of the family and other pressing issues that were more important than my little side hobby and thus crowded it out. True, the absence was only a week and a half, but it’s weird nonetheless. Sometimes, it’s hard to pick a subject. Fortunately (or unfortunately), over the weekend I started seeing memes and content on various social media that went something like this about “only 6%,” as shown by this collection of memes from @BadCOVID19Takes:
Many of them reference this blog post by one of the most idiotic right wing pundits out there, The Gateway Pundit:
The CDC silently updated their numbers this week to show that only 6% of all coronavirus deaths were completely due to the coronavirus alone. The rest of the deaths pinned to the China coronavirus are attributed to individuals who had other serious issues going on.
Jim Hoft, a.k.a. The Gateway Pundit, then went on to quote a Tweet by someone going by the handle Mel Q (@littllemel):
Unsurprisingly, Mel Q was overjoyed to have had her Tweet retweeted by President Trump:
It was very disturbing indeed that President Trump chose to amplify this disinformation that “only 6%” of deaths attributed to COVID-19 had actually died of COVID-19 “alone” and that “only 9,210” had died from COVID-19. (Of course, these figures are a bit old, from when “only 153,504” died of COVID-19. The toll today is widely thought to be north of 180,000, which, according to the brain dead “logic” of people like Mel Q, would mean that “only” close to 11,000 people died of “only” COVID-19.)
This claim was rapidly amplified by COVID-19 denialists (those who deny that COVID-19 is deadly and that we need to take the pandemic seriously, instituting social distancing, masking, and in some cases lockdowns to control it), for example:
We’ve met Nick Gillespie before, when he spewed nonsense about the right-to-try and drug approval by the FDA. I’m not surprised that he swallowed disinformation about COVID-19 whole and then regurgitated it unthinkingly.
Amplification of the “only 6%” gambit also included Tweets by various conservative actors and celebrities, like Kevin Sorbo:
Unfortunately, even after Twitter deleted Mel Q’s Tweet, the “only 6%” hashtag is still going strong on Twitter.
I’m sure we’d all agree that this would be awesome if it were true! If “only 6%” of those who died with COVID-19 have actually died because of the coronavirus instead of dying of something else “with” the coronavirus at the same time, then it really would be true that the disease is much less dangerous than previously thought. Sadly, this claim is a huge truckload of fetid dingos’ kidneys piled on with a thick layer of bovine excrement. It’s a misrepresentation of the figures in this chart. Whether it’s unintentional or intentional can be debated. (Actually, to me it can’t. I know we’re not supposed to attribute to malice what can be explained by stupidity, but in the case of COVID-19 deniers I’ve learned that malice and stupidity are usually both involved.)
Overall, the message was similar to previous messages by COVID-19 deniers:
- That COVID-19 death tolls are being intentionally exaggerated by the media and government for nefarious purposes, in this case the “true” toll is “only 6%” of the toll usually cited.
- That “only” the sick and the old are at risk.
- That you don’t have to worry about COVID-19 if you don’t have one or more of the comorbid conditions listed.
- That, because “only 6%” died of “only COVID-19,” lockdowns, social distancing, masks, etc., are unnecessary.
I sensed an astroturf campaign, much like the one that tried to promote hydroxychloroquine based on hilariously awful “science” not too long ago. But what’s behind it? Much in the manner that the campaign to promote hydroxychloroquine based on risibly bad epidemiology two weeks ago, this astroturf campaign to downplay the risk of COVID-19 (“only 6%” of what you thought it was!) is based on a laughably incompetent and awful interpretation of CDC statistics, with a dash of conspiracy theory thrown in (the CDC “quietly updated the COVID number,” as though the CDC was trying to hide something), because there’s always a conspiracy theory. Adding to the conspiracy theory was Twitter’s deletion of the original Tweet by Mel Q that had been retweeted by President Trump.
Also, note the “Q” in Mel Q’s Twitter handle. That’s not just any “Q.” It’s clearly a reference to QAnon, an utterly bonkers far right conspiracy theory that claims (among many other things) that a network of Satan-worshiping pedophiles—and cannibals who apparently eat the children after abusing them!—are running a global child sex-trafficking ring and are (not coincidentally) trying to take down U.S. President Trump, who, unsurprisingly, has refused to denounce QAnon as the dangerous nonsense that it is.
Worse, the idea has spread from the wingnutosphere into mainstream news. I’ve lost count of the number of stories in mainstream news sources that basically parrot (or at least don’t push back very much against) the idea that the CDC has somehow admitted that “only 6%” of those dying with COVID-19 died of COVID-19, although, fortunately, that changed as the weekend wore on, Trump retweeted the claim, and Twitter took down Mel Q’s Tweet. Unfortunately, that didn’t stop “only 6%” from going viral and trending on Twitter:
I also saw it all over Facebook, even in a Star Trek group that I joined a long time ago.
So what’s behind this “only 6%” gambit? Basically, on August 26, the CDC updated its breakdown of COVID-19 deaths in the US, and one of the tables has deaths categorized by what are described as “comorbidities.” Where did the “only 6%” figure come from? If you peruse the table first, as I did, you’ll have a hard time figuring it out, but then I looked at how the table (Table 3) is described on the CDC website:
Table 3 shows the types of health conditions and contributing causes mentioned in conjunction with deaths involving coronavirus disease 2019 (COVID-19). For 6% of the deaths, COVID-19 was the only cause mentioned. For deaths with conditions or causes in addition to COVID-19, on average, there were 2.6 additional conditions or causes per death. The number of deaths with each condition or cause is shown for all deaths and by age groups. For data on comorbidities, click here to download.
If you peruse the table itself, you’ll soon see that it doesn’t show that “only 6%” of COVID-19 deaths were due primarily to COVID-19 and that, among those with comorbid conditions who died, there were 2.6 additional conditions or causes. The only way one might make such an misinterpretation is either through a profound misunderstanding of how this table was compiled or through willfully lying about the significance of the figures in this table. For one thing, looking at the table you’ll see things like “cardiac arrest,” “septic shock,” “multiorgan failure,” and “respiratory failure.” These can all be sequelae of severe COVID-19 infection that ultimately lead to death; so it would be shocking if they weren’t on the table:
To understand how the CDC table was tabulated, let’s elaborate on the Tweet above. You have to understand that it was compiled from standardized death certificates. It’s been a long time since I’ve had to fill out a death certificate—thankfully!—but I still remember how they work. On the death certificate form, there is a space for the immediate cause of death and then several lines for underlying causes. In brief, death certificates are filled out by the medical certifier (who can be the physician who had treated the patient before death), who provides his best medical opinion regarding the cause of death. Part I of the death certificate includes the proximal cause of death, or what directly caused the death, and Part II lists conditions that contributed to the death:
For example, if a patient dies of respiratory failure due to acute respiratory distress syndrome (ARDS), which was the result of pneumonia, which was the result of COVID-19, the proximal cause of death was the respiratory failure, but contributing causes were ARDS and COVID-19, with the one farthest up the chain being the underlying cause of death under Part I. If the patient had hypertension or asthma, that would go under Part II. As I like to say, if you suffer a cardiac arrest due to blood loss after being shot, the cardiac arrest might have been the proximal cause of death, but you still died of a gunshot wound. Still, that didn’t stop the Twitter brain trust from asking idiotic questions like:
The answer is no. Anyone who has even the most rudimentary understanding of how death certificates are filled out would laugh at just how ignorant the person asking this question must be.
Sometimes these underlying causes contribute to the death. For example, if you have hemophilia and suffer a stab wound that leads you to bleed out and die when someone with normal blood clotting probably would have survived, then you still died of a stab wound, but the hemophilia was a contributing cause of death.
It’s really not that difficult to understand. Former fellow ScienceBlogs blogger Mark Hoofnagle Tweeted this:
And another, simpler, explanation:
And a couple of examples Tweeted three weeks before the “only 6%” disinformation campaign began:
It is true that sometimes determining the most important underlying cause isn’t always straightforward, but in the vast majority of COVID-19 cases it is. If someone with hypertension, obesity, and type 2 diabetes catches COVID-19, then develops pneumonia, then develops failure of multiple organ systems, and finally dies of respiratory failure, the proximate cause of death is respiratory failure, but the underlying cause of death is COVID-19, without which the respiratory failure never would have happened. Yes, it is well-known that certain conditions greatly increase your risk of dying if you contract COVID-19. These include, among several others:
- Age (the chance of dying of COVID-19 begins to increase dramatically after age 50 and becomes truly frightening by age 80)
- Obesity (BMI > 30)
- Being male
- Cancer
- Chronic kidney disease
- COPD (chronic obstructive pulmonary disease)
- Immunocompromised state (weakened immune system) from solid organ transplant
- Obesity (body mass index [BMI] of 30 or higher)
- Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
- Sickle cell disease
- Type 2 diabetes mellitus
These are contributory factors, but if you have one or more of these conditions when you contract COVID-19 and later die, it’ll very likely be the COVID-19, not your underlying health condition, that killed you. The underlying health condition(s) might have played a role in making you sicker, but it’ll be the virus that does you in.
Of course, the “only 6%” gambit is even more dishonest than it seems. Why? Because we have actual data published the same day as Table 3 telling us that. More importantly, the actual interpretation of the underlying data for the table shows:
In other words, COVID-19 is the underlying cause of around 92.3% of the deaths in the dataset, not 6%.
Also, the US isn’t the only country in the world with COVID-19. There are data from many other nations. As “Health Nerd” notes:
One important thing to note is that a lot of this is specific to the U.S. There are, oddly enough, quite a few other countries around the world, and they all have their own way of recording deaths. In some places, for example India, there has been a lot of criticism that the death reporting is shockingly bad and thus the country may be missing some or even the majority of their COVID-19 deaths. In other places, like Belgium, the death reporting is so good that it may explain the high COVID-19 death rates — they are simply picking up coronavirus deaths that other places have missed.
However, one thing remains true: most countries go to great lengths to ensure that deaths are correctly classified. Death reporting is incredibly important, and in most places it’s a detailed process that has to be checked carefully. In most cases, we can say with some certainty that deaths attributed to COVID-19 are, at best, a solid count, and at worst probably an underestimate. If anything, it’s likely that we are missing quite a few deaths that have been caused by coronavirus, but for whatever reason not picked up in our reporting systems, and thus the death count is actually higher than the reported figure.
And I say all of this as someone who has spent quite a bit of time studying COVID-19 death rates. I’ve now co-authored two studies looking at the fatality rates of COVID-19, and can say with some certainty that they are pretty good estimates, if probably a little low.
The bottom line is that the “only 6%” gambit is disinformation. It’s likely either astroturf or a product of the deranged minds of QAnon conspiracy theorists (or both). What’s most depressing is that we have a President who amplifies dangerous disinformation like this to a social media ecosystem of willing accomplices, allowing nonsense like this to go viral. As for the inevitable tone police trolls who will likely lament that I’m being way too sarcastic, insulting, and nasty, tough. Anything related to QAnon doesn’t deserve my civility.
