FARGO — A statistic from the U.S. Centers for Disease Control about Americans with no underlying medical conditions who’ve died from COVID-19 has become a major talking point on social media for people who claim the danger of the virus is being overplayed.

Dr. Paul Carson, an infectious disease specialist here, calls that “muddled thinking.”

The CDC reported that for 6% of the coronavirus 2019 deaths, COVID-19 was the only cause mentioned. The vast majority of others who died also had, on average, more than two underlying medical conditions, such as heart disease or diabetes.

The stat has been twisted into an incorrect claim that only 6% of the deaths were actually due to the virus, and thus, the death count should be far lower.

The claim was even removed from Twitter after being posted by an apparent QAnon follower and shared by President Donald Trump.

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Instead, Carson says the question should be whether the person would have died now from their underlying health condition if they had not gotten COVID-19.

“The vast majority of the time... the answer would be no,” he said.

The Forum recently sat down to discuss these and other findings with Carson, who is also a public health professor at North Dakota State University and consultant to the governor’s COVID-19 task force.

“If anybody is still talking about, ‘This is the same as the flu,’ that’s just nonsense. It’s absolute nonsense,” Carson said.

COVID contributes to ‘excess deaths’

Perhaps the best measure of COVID-19’s toll is a spike in overall deaths in the U.S.

The CDC, which tracks “expected” and “excess” deaths, found from 22% to nearly 40% more overall deaths in mid-April than would normally have been seen for that week, based on prior five year trends, Carson said.

Overall deaths have risen sharply in the U.S. since COVID-19 began circulating in the spring. Courtesy: U.S. Centers for Disease Control
Overall deaths have risen sharply in the U.S. since COVID-19 began circulating in the spring. Courtesy: U.S. Centers for Disease Control

The number dropped to around 8% more overall deaths in late June but has since risen again. Carson said information on the far right of the graphic is incomplete because of a lag in time between when deaths occurred and when they are represented here.

"You're waiting for the data to catch up," he said.

While most of the excess deaths, around 90%, were likely due to COVID-19, he said, others can be attributed to people being afraid to seek help with heart attack or stroke symptoms because of the pandemic, and to suicides.

Every age group, except those 25 and under, have seen higher than normal death rates since the onset of COVID. The older the age group, the larger the spike.

Carson is especially struck by excess deaths in people ages 25 to 44 and 45 to 64.

Overall deaths in the U.S. have risen in nearly every age group since COVID-19 began circulating in the spring. Courtesy: U.S. Centers for Disease Control
Overall deaths in the U.S. have risen in nearly every age group since COVID-19 began circulating in the spring. Courtesy: U.S. Centers for Disease Control

In the younger group, it was about a thousand more deaths per week, nationwide. For the older group, about 4,000 additional deaths per week.

“That’s a lot of people dying that wouldn't have otherwise died in that age group,” he said.

How contagious and deadly?

The virus that causes COVID-19 is nearly twice as contagious as most seasonal influenza and to a slightly lesser degree, the Spanish Flu of 1918, Carson said.

Its case fatality rate is, on average, 1.38%, or around 14 times more lethal than seasonal flu.

The rate could even be as high as 40 times more so, he said, when considering how the CDC uses mathematical modeling to calculate flu mortality.

In his 35 years of practice, Carson has never seen a flu season where semi trailers were parked outside of hospitals to serve as temporary morgues, which occurred this year in New York City, Texas and in Italy.

“That never happens... nothing remotely close,” Carson said.

Statistics about how COVID-19 compares with seasonal influenza and the 1918 flu pandemic come from an article co-authored by Dr. Paul Carson and published in a recent issue of the Catholic Medical Association.
Statistics about how COVID-19 compares with seasonal influenza and the 1918 flu pandemic come from an article co-authored by Dr. Paul Carson and published in a recent issue of the Catholic Medical Association.

However, COVID-19 appears less deadly, at this point, than the 1918 pandemic.

It’s killed more than 186,000 Americans thus far. The Spanish Flu claimed well over 650,000 American lives over a two year period, according to the CDC.

To date in North Dakota and Minnesota, 150 people and 1,847 people have died with COVID-19, respectively.

For context, heart disease killed 1,326 people and cancer killed 1,280 in North Dakota in 2017, according to the CDC.

In Minnesota, cancer killed 9,896 people and heart disease 8,230 that same year.

The highly contagious coronavirus, however, will only increase the risk of death for people who are already suffering from those illnesses.

Unacceptable deaths

Seasonal influenza typically circulates from late fall through the springtime, but COVID-19 isn’t following that schedule.

For most of the country, the virus showed up in early spring, after seasonal flu had already peaked, and is still going strong.

To date, more than 6 million Americans have been infected.

“We don't know if, when and how COVID will end,” Carson said.

Dr. Paul Carson, an infectious disease physician and public health professor at NDSU, talks about coronavirus at the university on Thursday, March 12. Chris Hagen / The Forum
Dr. Paul Carson, an infectious disease physician and public health professor at NDSU, talks about coronavirus at the university on Thursday, March 12. Chris Hagen / The Forum

It’s presumed all of the population is susceptible to the virus until further science shows some people are less at risk.

The highly infectious COVID-19 could march through the population until 50% to 70% are infected before it slows down from herd immunity.

“That’s a lot of people sick. That's a lot of potential deaths,” Carson said.

If the U.S. were to let the virus spread without mitigation in an attempt to reach herd immunity, there would be more than one million Americans dead, he said, a number that’s “unacceptable to most people in public health.”

Role of underlying conditions

Almost half of the U.S. population, on average, has at least one medical condition that puts them at higher risk for having a severe complication of COVID-19, Carson said.

Many people have multiple such conditions.

For example, people have twice the risk of a serious outcome from COVID-19 if they’re over age 44.

If they’re obese, with a body mass index of over 40, the risk is two and a half times higher.

With congestive heart failure, the risk of a serious outcome is four times higher, and being older than age 75 brings a 38-fold risk.

Interestingly, obesity on its own raises a person’s risk of serious complications of COVID-19, even when they have no accompanying conditions such as diabetes or kidney disease.

“It stands alone,” Carson said, adding that more than 42% of the U.S. population is classified as obese.

Reducing the incidence of obesity and serious illnesses such as heart and lung disease and diabetes would go a long way toward lowering people’s risk for COVID-19; however, those can be complicated health problems that take considerable time to fix or improve.

In the short term, the best advice about COVID-19 is “don’t get exposed,” Carson said, in reference to wearing a mask, keeping physical distance from others and using good hand hygiene.

Principal vs. secondary cause of death

When a physician fills out a death certificate, they’re asked to list the principal cause of death in their best estimation, Carson said.

If a person contracts COVID-19 in a nursing home and is transferred to a hospital, where they die of a heart attack with a history of congestive heart failure, the principal cause of death would be heart attack.

Secondary factors would be congestive heart failure and recent COVID diagnosis.

If that seems fishy to people, it’s not, Carson said. It’s the way death certificates have been done for years.

“If anything, I believe we undercount COVID-related deaths,” he said.

Undercounting is likely still a problem, he said, because some people infected with the virus end up dying at home without ever being tested or seeing a doctor.

How COVID compares to H1N1

Some people have tried to compare the H1N1 flu pandemic of 2009-2010 with COVID-19, saying it was just as bad during a time when President Barack Obama was in office.

H1N1 caused just over 12,400 deaths in the U.S. during that flu season, according to the CDC.

“It was not one of our worst pandemics,” Carson said.

In North Dakota, there were just four influenza deaths that season, two of which were attributed to H1N1, according to Levi Schlosser, influenza surveillance coordinator for the state department of health.

The worst flu span in recent memory happened in 2017-2018.

That season, North Dakota recorded 31 influenza and 520 pneumonia deaths, some of which were likely attributed to influenza, Schlosser said.

Minnesota had 440 influenza deaths in that period, according to the state department of health.

Schlosser predicts much more scrutiny this fall over how seasonal influenza is monitored and reported, as it’s expected to circulate along with COVID-19.

He encourages people to get a seasonal flu shot as soon as it becomes available.

As for COVID-19, Carson said it’s very important that the U.S. gets a safe and effective vaccine.

“That is our only way out of this,” he said.

Look for another story soon from reporter Robin Huebner about how COVID-19 has impacted the number of deaths in local long-term care centers.

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