(TMU Op-Ed) — There seems to be a lot of confusion about the novel coronavirus including the basics like the difference between the name of the virus and the name of the disease. I’m going to attempt to clear a few things up but also ask some important questions.
The novel coronavirus is called SARS-CoV-2. It was named by the World Health Organization (WHO) on February 11. SARS-CoV-2 stands for severe acute respiratory syndrome coronavirus 2 and it is a virus just like strains of influenza are also viruses. I am not mentioning this to say that they are similar, I am simply drawing the comparison that they are both indeed viruses. Likewise, HIV is a virus and not a disease.
Some people who are infected with SARS-CoV-2, the virus, go on to develop CoViD-19, the disease that is caused by the virus.
As you can see in this article that I published on February 11, the disease was also named by the WHO on February 11. CoViD-19 stands for corona virus disease 2019—the year in which it was first discovered.
Unfortunately, people on the internet, journalists, and oddly enough even some medical professionals are not distinguishing between these two things. Not only is this incredibly confusing but it’s allowing a lot of room for doubt and conspiracy in places where there shouldn’t be.
And instead of correcting these errors or speaking up about the confusion, the World Health Organization quietly changed the way that it refers to the virus.
“From a risk communications perspective, using the name SARS can have unintended consequences in terms of creating unnecessary fear for some populations, especially in Asia which was worst affected by the SARS outbreak in 2003.
For that reason and others, WHO has begun referring to the virus as “the virus responsible for COVID-19” or “the COVID-19 virus” when communicating with the public. Neither of these designations are intended as replacements for the official name of the virus as agreed by the ICTV.
Material published before the virus was officially named will not be updated unless necessary in order to avoid confusion.”
Why would the WHO make this switch from two very different names for the virus and the disease to using virtually the same name for both? I believe that advising folks to not call it the Chinese Virus or the Wuhan Virus is reasonable, but what exactly are the unintended consequences of using SARS in the virus name? 774 died from SARS. At least 118,304 people have already died from SARS-CoV-2.
Anyway, it is very important to make this distinction and to understand that CoViD-19 is a disease.
Most people have experienced how viruses exist on a bit of a spectrum—from not a big deal to deadly pandemic. Sometimes a virus can invade our body but our body fights it off and we don’t even have any noticeable symptoms. Sometimes a virus invades our body and begins to replicate by hijacking our cells and destroying them as the virus multiplies. This can make us sick.
Some common viruses include hepatitis, influenza, rubeola, mumps, rubella, human immunodeficiency virus (HIV), herpes, dengue virus, Ebola virus, and varicella zoster virus. Some viruses go on to cause infectious diseases such as influenza, acquired immunodeficiency syndrome (AIDS), dengue fever, Ebola, and chicken pox.
So let’s take a step back and look at what we have. We have a virus called SARS-CoV-2. And we have a disease called CoViD-19.
The nasal swab test, the most common way to test, looks for the virus. The results are positive or negative, indicating that the virus is either in you or it isn’t. You might have symptoms and you might not. The nasal swab test does not test for the disease, CoViD-19. So why is it that many of the maps, most of the articles, and even statements from doctors talk about someone being positive or negative for CoViD-19? This isn’t possible.
This is an especially important point to consider for those that think the death counts and the total cases of those infected with the viruses are being falsified.
If you are very ill and you go into the hospital because you can’t breathe, the attending team of healthcare providers is going to try to help you breathe. They want to save your life. I’m not a doctor or a nurse but I can say with certainty that their goal is to help you as quickly and as efficiently as possible, not to prove whether or not you have SARS-CoV-2 replicating inside of your body. While new and quicker technology is being explored and used, the results of the common nasal swab tests can take 3-5 days to return. When a patient can’t breathe they generally don’t have 3-5 days to wait and decide what to do. So the team does what medical professionals who have the goal of saving lives in a fast paced environment do, pandemic or not—they look at the available evidence in front of them and act on it.
For patients ill thanks to the coronavirus, observing the patient and doing things like looking at the blood oxygen saturation level and checking for anomalies in X-rays and CT scans of the lungs will help a doctor decide if a patient has the disease CoViD-19 or not.
Do you think if the nasal swab test came back negative the course of care would change? What if it were you in that hospital bed and your nasal swab came back negative? Would you want them to continue moving forward with your care as if you have CoViD-19 to save your life? Or stop and say it’s a dead end because you tested negative? Would you then go home? Undergo an expensive battery of tests? What exactly would be acceptable?
Again, we have a virus and we have a disease. And we have a test that tests for the virus, not the disease. We are also seeing asymptomatic people and varying levels of severity when it comes to symptoms. But we are not being told if these are symptoms of the virus or the disease or if the symptoms of these two things are different. From the anecdotal evidence out there, it seems like they might be a bit different.
Could it look something like this?
- Can you have a positive SARS-CoV-2 test and not have symptoms because your body is winning?
- Can you have a positive SARS-CoV-2 test and have basic symptoms, because you have a viral infection? Not a disease.
- Can you have a positive SARS-CoV-2 test, have basic symptoms, and also have symptoms of CoViD-19, the disease?
- Can you have a negative SARS-CoV-2 and have symptoms of CoViD-19, because the virus ran its course and you no longer have an active infection but you do have the resulting disease that some people end up with after being infected by SARS-CoV-2?
If so, this might clear up some of the confusion about false negatives because they might not be false. You might be done with the virus but still suffering from the disease.
Making this distinction calls into question all of the data that is being tracked. On these tracking maps are we simply tracking positive test results of people who, at the time of testing, were actively infected with SARS-CoV-2? Is anyone keeping track of how many people have been diagnosed with CoViD-19?
Speaking of being diagnosed with CoViD-19, I mentioned it a little while ago that CT scans and X-rays and blood oxygen saturation levels in addition to probably other things that I am not aware of are being used to decide if someone has CoViD-19 or not. Some people think that this is a terrible thing and a sign that there is some sort of fraud happening here. But it would help to really understand how diseases are diagnosed, especially in a life or death situation.
Personally, I have firsthand experience with being diagnosed with lupus and my mom being diagnosed with MS. A single test cannot diagnose someone with lupus. There isn’t magic indicator to look for. In fact there is a list of 11 things and you must be experiencing at least four of them to secure a diagnoses. When I was a kid some doctors looked at that list and thought that I had lupus. Other doctors looked at that list and didn’t think I had lupus. They didn’t agree because there is no magic test, it’s a list and so it’s a little open to interpretation. Sometimes this happens in medicine. It isn’t black and white. I know you want CoViD-19 to be black and white but it isn’t, and that isn’t weird or suspicious. Likewise, no single test can diagnose MS. Have you heard of Lyme disease? That’s diagnosed based on symptoms and physical findings. Again, normal.
So if you’re incredibly upset that CoViD-19 is being written on death certificates when the results of a nasal swab have yet to be confirmed, I don’t think you understand how any of this works.
Let’s talk about death certificates for a moment. Check out this 2003 CDC manual called Physicians’ Handbook on Medical Certification of Death. It really makes it clear how death certificates are supposed to be completed. In the excerpt below, it clearly lays out that more than one thing can and should be written on a death certificate because there is often a chain of events that occurs, ultimately resulting in death.
“This section must be completed by either the attending physician, the medical examiner, or the coroner. The cause-of-death section, a facsimile of which is shown below, follows guidelines recommended by the World Health Organization. An important feature is the reported underlying cause 9 of death determined by the certifying physician and defined as (a) the disease or injury that initiated the train of morbid events leading directly to death, or (b) the circumstances of the accident or violence that produced the fatal injury. In addition to the underlying cause of death, this section provides for reporting the entire sequence of events leading to death as well as other conditions significantly contributing to death (5).
The cause-of-death section is designed to elicit the opinion of the medical certifier. Causes of death on the death certificate represent a medical opinion that might vary among individual physicians. A properly completed cause-of-death section provides an etiologic explanation of the order, type, and association of events resulting in death. The initial condition that starts the etiologic sequence is specific if it does not leave any doubt as to why it developed. For example, sepsis is not specific because a number of different conditions may have resulted in sepsis, whereas human immunodeficiency virus syndrome is specific.
In certifying the cause of death, any disease, abnormality, injury, or poisoning, if believed to have adversely affected the decedent, should be reported. If the use of alcohol and/or other substance, a smoking history, a recent pregnancy, injury, or surgery was believed to have contributed to death, then this condition should be reported. The conditions present at the time of death may be completely unrelated, arising independently of each other; they may be causally related to each other, that is, one condition may lead to another which in turn leads to a third condition; and so forth. Death may also result from the combined effect of two or more conditions.”
Right now, we have people up in arms all across the country right now claiming that death certificates aren’t accurately detailing what people are dying from. There are claims that if people are very obese, if they have cancer, if they have heart disease, etc. they are being listed as CoViD-19 deaths despite those other things being part of what caused them to die. But it looks like death certificates have spaces to account for this. Doctors are already instructed to detail the chain of events that lead to death which might include a disease in addition to an infection or even another disease.
If you have a problem with the way death certificates are completed, which it seems some doctors who are making viral videos of themselves on this topic do, your issue is with the forms and the process, not CoViD-19. Sorry but in the middle of a deadly global pandemic is not the time to complain about death certificates.
The CDC also has a document specific to deaths due to coronavirus disease. Take a look. I’d like to highlight a few specific parts:
“When reporting cause of death on a death certificate, use any information available, such as medical history, medical records, laboratory tests, an autopsy report, or other sources of relevant information. Similar to many other diagnoses, a cause-of-death statement is an informed medical opinion that should be based on sound medical judgment drawn from clinical training and experience, as well as knowledge of current disease states and local trends (6).”
“Other significant conditions that contributed to the death, but are not a part of the sequence in Part I, should be reported in Part II. Not all conditions present at the time of death have to be reported—only those conditions that actually contributed to death.”
“If COVID–19 played a role in the death, this condition should be specified on the death certificate. In many cases, it is likely that it will be the UCOD, as it can lead to various lifethreatening conditions, such as pneumonia and acute respiratory distress syndrome (ARDS). In these cases, COVID–19 should be reported on the lowest line used in Part I with the other conditions to which it gave rise listed on the lines above it.
In some cases, survival from COVID–19 can be complicated by pre-existing chronic conditions, especially those that result in diminished lung capacity, such as chronic obstructive pulmonary disease (COPD) or asthma. These medical conditions do not cause COVID–19, but can increase the risk of contracting a respiratory infection and death, so these conditions should be reported in Part II and not in Part I.”
More than what’s being recorded on death certificates, deaths in general are up in some epicenters. Here’s a great graph that shows that potential undercounting of deaths:
Plot⬇️from @nytimes clearly shows UNDERCOUNTING of #COVID deaths in NYC.
"Anomaly" variables are often used in physical sciences. Anomalies are calculated by subtracting the average of a variable from its observed values, therefore revealing its temporal &/or spatial variability. pic.twitter.com/5Mg8XKL0Da
— Dr. Safa Mote (@SafaMote) April 11, 2020
Sure, maybe we have a few deaths attributed to CoViD-19 that shouldn’t have been. That’s inevitable. Mistakes do happen. But how many deaths due to CoViD-19 or the novel coronavirus haven’t been counted? And won’t be counted? That includes deaths that happened earlier this year. That includes people dying at home. That includes people dying in nursing homes. For every one case overcounted, there may be 5, 10, or 50 undercounted.
But the truth is that we’ll never quite know for sure. We don’t have an accurate look at one year’s flu data until the next season. This takes time, and even then it’s still just an estimate.
So the next time somebody tells you the numbers are being inflated and that death certificates are being manipulated, show them this article or the video included below. Or better yet, check out the documents linked to in this article and look at the information yourself and respond to people in your own words.
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