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Our COVID-19 Death Certificate Review Service
Our agency will review, at NO CHARGE, the Death Certificate of a loved one due to COVID-19. The death certificate may come only from the Next-of-Kin or Informant as stated on the Death Certificate. Please follow the specific instructions at this intake form, and where the redacted Death Certificate can be uploaded – www.DeathCaseReview.com/intake-covid.html.
This is the only manner in which to submit the request.
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COVID-19 DEATH CERTIFICATE REVIEW SERVICE
Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS) provide requirements for completing Death Certificates to all state health departments, county health departments, and persons authorized to complete Death Certificates and certify deaths. This is found at - www.cdc.gov/nchs/data/dvs/blue_form.pdf
As former Deputy Coroners, we were trained and experienced in these requirements and process. Only licensed physicians and certain higher-level non-physicians in some states (i.e. nurse practitioners and physician assistants), and coroners / medical examiners and their deputies. This process is not taught in medical school, and in our experience the Forensic Pathologists are the most experienced and knowledgeable – this is where our training and experience came from.
Of importance on the Death Certificates is the Cause of Death statement – there are two parts – Part 1 and Part 2.
Part 1 – is a chronological chain of events from Immediate Cause back to the sequential list of events leading to the death. A terminal event, such as “Cardiac Attack” or “Respiratory Arrest” by themselves are not allowed – there must be a sequential list of events.
-- For this reason, “COVID-19” by itself is not acceptable.
Part 2 – Other Significant Conditions which contributed to death; however, are not listed in Part 1 above. These are not part of the underlying cause of death.
-- For this reason, “COVID-19” will rarely appear in Part 1 and is best in Part 2.
Multiple sequences and conditions will have the most likely in Part 1 and other conditions in Part 2.
- We strongly suggest viewing the example above for a clear understanding of Part 1 and Part 2, and the nuances of what is placed in each section.
Although COVID-19 is a known respiratory virus which may lead to other conditions ultimately causing death (UCOD), and death reporting should have been consistent with all other reporting, COVID deaths resulted in CDC issuing new guidance specific to reporting - www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf.
COVID-19 is a respiratory virus. An example of the progression (etiology) is the decedent develops COVID-19, which progresses to Pneumonia, then Severe Acute Respiratory Syndrome (SARS) resulting in death. The Death Certificate may read:
Part 1 – 1a. SARS, 1b. as consequence of Pneumonia, 1c. as a consequence of COVID-19 – IF there were no other contributory disease processes.
-- If the decedent had pre-existing health conditions – comorbidities – which caused their death, and COVID was a contributor, the Death Certificate should read in Part 1 the comorbidity sequence chronologically and COVID last.
-- If the decedent’s comorbidities did cause their death, and COVID was not a contributor, the Death Certificate should read in Part 1 the comorbidity sequence, and in Part 2 COVID.
At least initially, and continuing without amending their reporting, deaths suspected of COVID or test positive without symptoms or diagnosis were and are reported as COVID (this includes differential diagnosis to exclude more common and likely ailments). From the above CDC COVID-19 guidance, “In cases where a definite diagnosis of COVID–19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID–19 on a death certificate as “probable” or “presumed.” In these instances, certifiers should use their best clinical judgement in determining if a COVID–19 infection was likely. However, please note that testing for COVID–19 should be conducted whenever possible.” [emphasis added]
Finally, in September 2020 the CDC issued the following:
> What about the case of a known or possible exposure to COVID-19? Should certifiers report these on the death certificate?
>> Certifiers should not report “exposure to COVID-19” or “possible exposure to COVID-19” on death certificates. A person may be exposed to the virus, but that does not mean the patient contracted or became infected with the virus, developed the disease (exhibited its signs or symptoms), or that it caused or contributed to the death. Certifiers should only report medical conditions that they determine to be a cause of death on the death certificate.
Conversely, COVID-19 should not be listed on the death certificate if the certifier determines it was not a likely cause of death.
> Should the certifier report COVID-19 on the death certificate for every case with confirmed positive test results for COVID-19?
>> No, COVID-19 should not be reported on the death certificate as a cause of death for every case with confirmed positive test results for the virus that causes COVID-19. Certifiers should report COVID-19 on the death certificate only if they determine that the person developed the disease (exhibited its signs or symptoms) and that COVID-19 caused or contributed to the death.
CDC New Rules and Reversal With Dual Stats
In June 2020 the CDC and several states and counties, including Colorado, changed their COVID ‘dashboard’ of statistics to show two sets of deaths attributed to COVID:
1) Deaths Among Cases for those having tested positive; and 2) Deaths Due to COVID-19.
Diagnosis of COVID was initially based on symptoms, and then on testing – which testing was not designed for and does not exclusively do so for COVID (this includes differential diagnosis to exclude more common and likely ailments). The following are symptoms of COVID and the common flu from CDC, with the symptoms reported only in COVID underlined. Further note, the symptoms are not exclusively indicative of having either COVID or the flu. Additionally, a ‘case’ stopped including symptoms when testing became free and went from hundreds a week to thousands a day per state and county.
As former Deputy Coroners, we were trained and experienced in these requirements and process. Only licensed physicians and certain higher-level non-physicians in some states (i.e. nurse practitioners and physician assistants), and coroners / medical examiners and their deputies. This process is not taught in medical school, and in our experience the Forensic Pathologists are the most experienced and knowledgeable – this is where our training and experience came from.
Of importance on the Death Certificates is the Cause of Death statement – there are two parts – Part 1 and Part 2.
Part 1 – is a chronological chain of events from Immediate Cause back to the sequential list of events leading to the death. A terminal event, such as “Cardiac Attack” or “Respiratory Arrest” by themselves are not allowed – there must be a sequential list of events.
-- For this reason, “COVID-19” by itself is not acceptable.
Part 2 – Other Significant Conditions which contributed to death; however, are not listed in Part 1 above. These are not part of the underlying cause of death.
-- For this reason, “COVID-19” will rarely appear in Part 1 and is best in Part 2.
Multiple sequences and conditions will have the most likely in Part 1 and other conditions in Part 2.
- We strongly suggest viewing the example above for a clear understanding of Part 1 and Part 2, and the nuances of what is placed in each section.
Although COVID-19 is a known respiratory virus which may lead to other conditions ultimately causing death (UCOD), and death reporting should have been consistent with all other reporting, COVID deaths resulted in CDC issuing new guidance specific to reporting - www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf.
COVID-19 is a respiratory virus. An example of the progression (etiology) is the decedent develops COVID-19, which progresses to Pneumonia, then Severe Acute Respiratory Syndrome (SARS) resulting in death. The Death Certificate may read:
Part 1 – 1a. SARS, 1b. as consequence of Pneumonia, 1c. as a consequence of COVID-19 – IF there were no other contributory disease processes.
-- If the decedent had pre-existing health conditions – comorbidities – which caused their death, and COVID was a contributor, the Death Certificate should read in Part 1 the comorbidity sequence chronologically and COVID last.
-- If the decedent’s comorbidities did cause their death, and COVID was not a contributor, the Death Certificate should read in Part 1 the comorbidity sequence, and in Part 2 COVID.
At least initially, and continuing without amending their reporting, deaths suspected of COVID or test positive without symptoms or diagnosis were and are reported as COVID (this includes differential diagnosis to exclude more common and likely ailments). From the above CDC COVID-19 guidance, “In cases where a definite diagnosis of COVID–19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID–19 on a death certificate as “probable” or “presumed.” In these instances, certifiers should use their best clinical judgement in determining if a COVID–19 infection was likely. However, please note that testing for COVID–19 should be conducted whenever possible.” [emphasis added]
Finally, in September 2020 the CDC issued the following:
> What about the case of a known or possible exposure to COVID-19? Should certifiers report these on the death certificate?
>> Certifiers should not report “exposure to COVID-19” or “possible exposure to COVID-19” on death certificates. A person may be exposed to the virus, but that does not mean the patient contracted or became infected with the virus, developed the disease (exhibited its signs or symptoms), or that it caused or contributed to the death. Certifiers should only report medical conditions that they determine to be a cause of death on the death certificate.
Conversely, COVID-19 should not be listed on the death certificate if the certifier determines it was not a likely cause of death.
> Should the certifier report COVID-19 on the death certificate for every case with confirmed positive test results for COVID-19?
>> No, COVID-19 should not be reported on the death certificate as a cause of death for every case with confirmed positive test results for the virus that causes COVID-19. Certifiers should report COVID-19 on the death certificate only if they determine that the person developed the disease (exhibited its signs or symptoms) and that COVID-19 caused or contributed to the death.
CDC New Rules and Reversal With Dual Stats
In June 2020 the CDC and several states and counties, including Colorado, changed their COVID ‘dashboard’ of statistics to show two sets of deaths attributed to COVID:
1) Deaths Among Cases for those having tested positive; and 2) Deaths Due to COVID-19.
Diagnosis of COVID was initially based on symptoms, and then on testing – which testing was not designed for and does not exclusively do so for COVID (this includes differential diagnosis to exclude more common and likely ailments). The following are symptoms of COVID and the common flu from CDC, with the symptoms reported only in COVID underlined. Further note, the symptoms are not exclusively indicative of having either COVID or the flu. Additionally, a ‘case’ stopped including symptoms when testing became free and went from hundreds a week to thousands a day per state and county.
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COVID Symptoms
www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html “People with these symptoms may have COVID-19”
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Influenza Symptoms
www.cdc.gov/flu/symptoms/symptoms.htm “People who have flu often feel some or all of these symptoms”
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County and State Conflicts in Reporting
County and States Required Reporting of COVID Positive Tests in 30-60 Days Prior to Death
The COVID PCR testing for the strain RNA is based on testing developed BEFORE the COVID-19 strain (COVID has been around for centuries); it could not – and still has not – been developed specifically for COVID-19, it will detect the common flu. Until 2020, a new strain was not alarming or an emergency, or tested for, or a vaccine created for. Rules were immediately and progressively changed. For example, testing from June 2020 was pushed for every person to be tested to ‘better understand the spread’. Prior to 2020, the CDC and state health departments stated these groups have testing priority:
-- Tier 1: Hospitalized patients, health care workers with symptoms
-- Tier 2: Patients in long-term care facilities or other residential settings, such as homeless shelters or correctional facilities, with symptoms; patients over age 65 with symptoms; patients with underlying conditions with symptoms; first responders with symptoms; critical infrastructure workers with symptoms; people with symptoms who work with vulnerable populations or in group residential settings
-- Tier 3: Other individuals with symptoms
Certain people are at higher risk of getting very sick [every time - not just this time]:
-- Older people (over age 60), especially those over 80 years.
-- People who have chronic medical conditions like heart, lung, or kidney disease, or diabetes.
-- Older people with chronic medical conditions are at greatest risk.
Moreover, in August 2020 Ivermectin had been used for several months to stop COVID in patients within 48 hours. The National Institute of Health (NIH) published an opinion on 08/27/2020 against doctors prescribing this medication. Testing increased, reported cases (without diagnosis or symptoms - including differential diagnosis to exclude more common and likely ailments)) increased, deaths increased – all which had been flat since 06/01/2020. On 01/15/2021 the NIH changed their opinion to being neither ‘for or against’ prescribing the medication, and gave recommended dosages. During this same August to January time frame, the CDC recommended the COVID PCR RNA testing be expanded to further magnify the sample (50x when all previous studies showed more than 32x created unacceptable false positives). In January 2021 the CDC recommended returning to below 32x.
Finally, specific testing used from November 2020 to January 2021, particularly in larger facilities (prisons, jails, hospitals, elder care facilities) was stopped as having unacceptably high false positives. In Colorado over 715,000 tests were completed, averaging 70,000 per week, with unknown false positives.
Proper Diagnosis
- Initially WA reported infections and deaths were skewed. Medical Examiners and the CDC stepped in and found issues with how deaths were coded and gave guidance. Over time those numbers began to be more consistent.
- Nationwide doctors have declined to sign out hospital cases as COVID after multiple negative tests, and still insisted by hospitals or health department officials requiring to do so (see NY, IL, PA among others). Several tests have been, instead, positive for hantavirus and swine flu after more testing.
- There is also still much confusion of when someone dies "of" COVID vs "with" or “exposure” to COVID - not the same thing or chain of events. [see below]
- Pennsylvania recently, multiple times, reduced their deaths after investigation into improper reporting, "These cases were previously reported as probable, but further review has determined that we needed more information before we could attribute them to a death related to COVID-19.”
- In NY they added more than 3700 deaths as COVID – as reported by the state health department, they "included more than 3700 people who never tested positive but were presumed to have died of it."
- The Illinois Public Health Director openly and blatantly directed improper coding of death certificates at a press conference.
- Colorado has similarly revised crisis deaths as COVID.
County and States Required Reporting of COVID Positive Tests in 30-60 Days Prior to Death
- Many local and state health departments require reporting any positive test 30-60 days prior to death be reported as COVID. This has include motorcycle and motor vehicle collisions, homicides and suicides, congenital birth defects, and others. A person need only Google these specific terms to find multiple media stories, videos and others.
The COVID PCR testing for the strain RNA is based on testing developed BEFORE the COVID-19 strain (COVID has been around for centuries); it could not – and still has not – been developed specifically for COVID-19, it will detect the common flu. Until 2020, a new strain was not alarming or an emergency, or tested for, or a vaccine created for. Rules were immediately and progressively changed. For example, testing from June 2020 was pushed for every person to be tested to ‘better understand the spread’. Prior to 2020, the CDC and state health departments stated these groups have testing priority:
-- Tier 1: Hospitalized patients, health care workers with symptoms
-- Tier 2: Patients in long-term care facilities or other residential settings, such as homeless shelters or correctional facilities, with symptoms; patients over age 65 with symptoms; patients with underlying conditions with symptoms; first responders with symptoms; critical infrastructure workers with symptoms; people with symptoms who work with vulnerable populations or in group residential settings
-- Tier 3: Other individuals with symptoms
Certain people are at higher risk of getting very sick [every time - not just this time]:
-- Older people (over age 60), especially those over 80 years.
-- People who have chronic medical conditions like heart, lung, or kidney disease, or diabetes.
-- Older people with chronic medical conditions are at greatest risk.
Moreover, in August 2020 Ivermectin had been used for several months to stop COVID in patients within 48 hours. The National Institute of Health (NIH) published an opinion on 08/27/2020 against doctors prescribing this medication. Testing increased, reported cases (without diagnosis or symptoms - including differential diagnosis to exclude more common and likely ailments)) increased, deaths increased – all which had been flat since 06/01/2020. On 01/15/2021 the NIH changed their opinion to being neither ‘for or against’ prescribing the medication, and gave recommended dosages. During this same August to January time frame, the CDC recommended the COVID PCR RNA testing be expanded to further magnify the sample (50x when all previous studies showed more than 32x created unacceptable false positives). In January 2021 the CDC recommended returning to below 32x.
Finally, specific testing used from November 2020 to January 2021, particularly in larger facilities (prisons, jails, hospitals, elder care facilities) was stopped as having unacceptably high false positives. In Colorado over 715,000 tests were completed, averaging 70,000 per week, with unknown false positives.
Proper Diagnosis
- Symptoms are not a diagnosis – they are part of a diagnosis.
- Proper diagnosis includes differential diagnosis to exclude more common and likely ailments, and effective medication regimens.
- Testing is not a diagnosis – it is part of a diagnosis, and only if the test is for the disease.
- The COVID-19 ‘cases’ were originally those with diagnosis and testing, until August 2020, when any positive test – unconfirmed by symptoms and/or diagnosis – was declared a ‘case’.
*** The above testing criteria and prohibited successful treatment were during the ‘surges’ and release of multiple vaccines.
For these reasons – Death Certificates need questioned. ***
For these reasons – Death Certificates need questioned. ***
Having COVID-19 at Death is NOT Dying of COVID-19
A person with COVID, who dies in a motorcycle collision after being struck by another vehicle, did not die of COVID.
A person who has died of certain health conditions, particularly respiratory and cardiac, and with COVID (by symptoms, diagnosis and testing – not just testing) may have died of COVID etiology – or not. A person may have had underlying health conditions (comorbidities) exacerbated by COVID and may have died of COVID etiology – or not.
- A person ‘with’ any disease does not necessarily die ‘of’ the disease.
A person with COVID, who dies in a motorcycle collision after being struck by another vehicle, did not die of COVID.
A person who has died of certain health conditions, particularly respiratory and cardiac, and with COVID (by symptoms, diagnosis and testing – not just testing) may have died of COVID etiology – or not. A person may have had underlying health conditions (comorbidities) exacerbated by COVID and may have died of COVID etiology – or not.
WHAT DOES THIS MEAN?
Throughout this event, and continuing, tens of thousands of people have died and may not have been – likely were not – due to COVID-19. It is that simple. Determining if so, or not, is not as simple. Perhaps we can help start the process.
YOU DESERVE FACTS AND CLOSURE – YOUR LOVED ONE IS NOT A STATISTIC
In May 2020 we wrote this opening paragraph to our monthly commentary (www.DeathCaseReview.com/afi-llc-blog/lessons-from-lockdown)
“Since mid-March we have all experienced an unprecedented event in our nation’s – our world’s – history: home isolation and closed businesses. The personal effects of emotional, physical, and mental health will begin to manifest themselves, and have been both trying and overwhelming for all. The impacts to our communities have been significant. The impact to our economies – personal, business, local, state and national – devastating.”
Our personal and business lives, as we were able, had no change – we strived to make sure we did not succumb to the fear. Unfortunately, we were still impacted by those gripped in this fear – and we continue to overcome all obstacles. Unfortunately, there are too many who have been victimized by this event – and specifically those who have lost a loved one or found themselves fighting for benefits and coverage they are entitled to and denied.
Do you have a client, family member or friend – or know of any – who have concerns of a misreported death, and may have lost benefits or tried to get a death certificate corrected? Being former Deputy Coroners experienced in certifying deaths and completing death certificates, we may be able to help. At no cost to the Next-of-Kin, we will review the death certificate and advise them if they have specific reasons to seek an amended death certificate. If so, we may be able to offer specific support. Time is important, as some insurance benefits have a one-year limit to a claim.
“Since mid-March we have all experienced an unprecedented event in our nation’s – our world’s – history: home isolation and closed businesses. The personal effects of emotional, physical, and mental health will begin to manifest themselves, and have been both trying and overwhelming for all. The impacts to our communities have been significant. The impact to our economies – personal, business, local, state and national – devastating.”
Our personal and business lives, as we were able, had no change – we strived to make sure we did not succumb to the fear. Unfortunately, we were still impacted by those gripped in this fear – and we continue to overcome all obstacles. Unfortunately, there are too many who have been victimized by this event – and specifically those who have lost a loved one or found themselves fighting for benefits and coverage they are entitled to and denied.
Do you have a client, family member or friend – or know of any – who have concerns of a misreported death, and may have lost benefits or tried to get a death certificate corrected? Being former Deputy Coroners experienced in certifying deaths and completing death certificates, we may be able to help. At no cost to the Next-of-Kin, we will review the death certificate and advise them if they have specific reasons to seek an amended death certificate. If so, we may be able to offer specific support. Time is important, as some insurance benefits have a one-year limit to a claim.
COVID Deaths – Natural vs. Other Reporting and Insurance Benefits
As we approach one year of the COVID pandemic – we also approach a year of improperly coded death certificates. At the onset in March 2020 our agency learned, and warned friends in media, for the first time in history the CDC changed the policy in how to certify and report a specific virus related death – there was no longer a distinction between ‘of’ a virus vs. ‘with’ a virus – there were to be treated and reported the same. We saw deaths in Washington and New York climb exponentially without related cause. Forensic Pathologists warned these and other state health departments of the issues – some were fixed by the end of April, most were not – and then the CDC and states, including Colorado, reported dual numbers of positive cases and deaths.
These reported non-COVID deaths were initially based on symptoms, and then presumptive positive tests when developed. When testing was developed, often there was no attempt at reporting symptoms or diagnosis (this includes differential diagnosis to exclude more common and likely ailments). This included a motorcycle accident, a domestic violence related homicide-suicide of a married couple, a newborn with a congenital birth defect, and many more. States, and other countries, were and still require any death with a positive test in the 30-60 days prior to be certified as COVID, regardless of the circumstances of death or differential diagnosis. In April 2020 the CDC attempted to correct their mistake in changing how to classify COVID specific virus related deaths.
To many this may be a statistical issue and of no other consequence. In the full scope of reality this not only severely skews the statistics, it also skews the perception of the public. Most important – it may cause individuals to lose certain health insurance coverages or life insurance benefits – perhaps even double-indemnity in cases of Accidents vs. Natural (motorcycle fatality Accident reported as COVID Natural).
These reported non-COVID deaths were initially based on symptoms, and then presumptive positive tests when developed. When testing was developed, often there was no attempt at reporting symptoms or diagnosis (this includes differential diagnosis to exclude more common and likely ailments). This included a motorcycle accident, a domestic violence related homicide-suicide of a married couple, a newborn with a congenital birth defect, and many more. States, and other countries, were and still require any death with a positive test in the 30-60 days prior to be certified as COVID, regardless of the circumstances of death or differential diagnosis. In April 2020 the CDC attempted to correct their mistake in changing how to classify COVID specific virus related deaths.
To many this may be a statistical issue and of no other consequence. In the full scope of reality this not only severely skews the statistics, it also skews the perception of the public. Most important – it may cause individuals to lose certain health insurance coverages or life insurance benefits – perhaps even double-indemnity in cases of Accidents vs. Natural (motorcycle fatality Accident reported as COVID Natural).