In April 2020, a conspiracy theory spread on Facebook and Twitter which maintained that the Centers for Disease Control and Prevention (CDC) explicitly ordered that all deaths in the United States, regardless of their true cause, be attributed to the novel coronavirus or COVID-19:
Variations on the rumor also appeared on Reddit:
Occasionally, the posts linked to blog posts about the rumors, writings which invariably attributed the CDC’s purported manipulation of the COVID-19 death toll (measured globally) to a conspiracy aimed at purposely destroying the American economy:
Although, an emerging body of evidence suggest shutting down an entire nation may not be a good idea after all to combat such a virus. As Ariel Pablos-Mendez, M.D., MPH a professor of Medicine at Columbia University Medical Center, New York and former head of global health at the U.S. Agency for International Development (USAID) explains:
At the end of the day, super-spreader COVID-19 is likely to infect a majority of the population, no matter how far apart we stay from one another in the coming weeks. The good news is that once immune, most people can go back to work. Our containment efforts must focus on the most vulnerable: the elderly and patients with underlying cardiopulmonary diseases.
We need to flatten the curve for the elderly but accelerate herd immunity for the healthy so that we don’t kill the economy trying to outrun the pandemic in lockdown. While home isolation for one month might stop an outbreak, it merely sets the clock back as the virus may return if it is not globally defeated.
As indicated above, COVID-19 spread globally — any assumptions that its reporting solely affected the United States conveniently elided its effects in other countries. Another subset of theories maintained that the purported inflation of COVID-19 death rates was a cash grab, in which hard-hit states like New York boosted the number of COVID-19 deaths to tap into lucrative federal assistance.
Those conspiracy theories were not consistent or congruent. Some claimed that the CDC or other entities would somehow profit more from a higher COVID-19 count of deaths; primarily, the claims were presented as proof that public health officials were gaming the statistics to somehow cause political harm to the sitting United States president.
Both linked posts appeared to be aggregations of a piece originally posted by the site GreatGameIndia.com from April 10 2020, itself predicated on a YouTube video uploaded by LibertyFellowshipMT four days earlier. The video featured a woman who identified herself as “Dr. Annie Bukacek,” who began by addressing the “alleged death rate of COVID-19.” (Bukacek was described as “no stranger to controversy” in a 2009 Rewire.News item about how she was investigated on multiple counts of Medicaid fraud in Montana; she also allegedly insisted that her patients pray with her.)
Bukacek then referenced answers to her own Facebook post, which queried people about their experiences with COVID-19. Bukacek derided the comments as anecdotal, and immediately thereafter put forth positions based only on anecdotes:
She began a speech peppered with emphasis on “quotes” and “end quotes”:
I posted the following question on Facebook yesterday: “Know anybody personally with baseline good health who has been hospitalized for COVID-19 alone, or allegedly died from COVID-19?”
I asked the question this way because if you know someone personally, you may know their baseline health status and some details of the case, and [testing positive] for COVID-19 does not mean you have the disease. Even asking the question this specifically, I still got some people saying their spouse knows a friend of a friend of a nephew in New York, and some who answered “yes” but didn’t give the details, even though I asked them, “could you please submit some more details?”
I got over 350 comments and received dozens of “no” answers, if not scores. Last I counted, there were 3 or 4 who answered “yes” and said their case fit the criteria, and they gave me some details. But even those 3 or 4, giving them the benefit of the doubt that they were answering honestly to the best of their knowledge, does that mean that the person they described was actually stricken with COVID-19?
Bukacek subsequently maintained that her experience with death certificates informed her position that COVID-19 was being overstated as a cause of death:
Few people know how much individual power and leeway is given to the physician, coroner, or medical examiner signing the death certificate. How do I know this? I’ve been filling out death certificates for over 30 years.
More often than we want to admit, we don’t know with certainty the cause of death when we fill out death certificates … that is just life. We are doctors, not God. Autopsies are rarely performed — and even when an autopsy is done the actual cause of death is not always clear. Physicians make their best guesstimate and fill out the form. Then that listed cause of death is entered into a vital records data bank to use for statistical analysis, which then gives out inaccurate numbers — as you can imagine. Those inaccurate numbers then become accepted as factual information, even though much of it is false.
So even before we heard of COVID-19, death certificates were based on assumptions and educated guesses that go unquestioned. When it comes to COVID-19 there is the additional data skewer, that is … get this … there is no universal definition of a COVID-19 death. The Centers for Disease Control, updated from yesterday, April 4th [2020], still states that mortality quote unquote data includes both confirmed and presumptive positive cases of COVID-19. That’s from their website.
Translation? The CDC counts both true COVID-19 cases and speculative guesses of COVID-19 the same. They call it death by COVID-19. They automatically overestimate the real death numbers, by their own admission.
On the subject of COVID-19 as a cause of death, Bukacek claimed:
To drive this home, we need to understand how the CDC – a national vital statistics system – are instructing physicians to fill out death certificates related to COVID-19. Brace yourselves and please pay attention, and let what I am about to tell you sink in.
The assumption of COVID-19 death could be made even without testing. Based on assumption alone, the death can be reported to the public as another COVID-19 casualty. The March 24th 2020 National Vital Statistics System Memo states:
“The rules for coding and selection of the underlying cause of death are expected to result in COVID-19 being the underlying cause more often than not.”
The CDC report of cases in the US memo from yesterday states the death numbers are “preliminary, and have not been confirmed.” That’s from the CDC website.
Here’s a quote even more laden with meaning. Steven Schwartz, national director of the Division of Vital Statistics says an answer to the question as stated in the organization’s COVID-19 alert, “Should COVID-19 be reported on the death certificate only with a confirmed test?”
Check out his answer, and I quote from this memo of which I have a copy:
“COVID-19 should be reported on the death certificate for all decedents where the disease caused, or is assumed to have caused, or contributed to death. Certifiers should include as much detail as possible based on their knowledge of the case, medical records, laboratory testing, etc.”
I’m sure you all feel so reassured the government is asking doctors to provide their very best guess work. Not.
Fact: “COVID-19 caused death” end of quote, and “assumed death by COVID-19″ end of quote are not the same thing, and for those who died from something else and had an incidental finding of COVID-19 positivity dying with COVID-19 is not the same as dying from COVID-19.
Bukacek referenced at least two documents in her talk — one of which was a March 24 2020 memo about COVID-19 mortality issued by the National Vital Statistics System [NVSS, PDF] and titled, “New ICD code introduced for COVID-19 deaths.” That reference, emphasis ours, appears above.
This is the actual text of that memo, with the questions underlined for clearer reading. That memo specifically described an introduction to a new ICD (International Classification of Diseases) code for COVID-19 deaths on death certificates.
New ICD code introduced for COVID-19 deaths
This email is to alert you that a newly-introduced ICD code has been implemented to accurately capture mortality data for Coronavirus Disease 2019 (COVID-19) on death certificates.Please read carefully and forward this email to the state statistical staff in your office who are involved in the preparation of mortality data, as well as others who may receive questions when the data are released.
What is the new code?
The new ICD code for Coronavirus Disease 2019 (COVID-19) is U07.1, and below is how it will appear in formal tabular list format.
U07.1 COVID-19
Excludes: Coronavirus infection, unspecified site (B34.2)
Severe acute respiratory syndrome [SARS], unspecified (U04.9)The WHO has provided a second code, U07.2, for clinical or epidemiological diagnosis of COVID-19 where a laboratory confirmation is inconclusive or not available. Because laboratory test results are not typically reported on death certificates in the U.S., NCHS is not planning to implement U07.2 for mortality statistics.
When will it be implemented?
Immediately.Will COVID-19 be the underlying cause?
The underlying cause depends upon what and where conditions are reported on the death certificate. However, the rules for coding and selection of the underlying cause of death are expected to result in COVID19 being the underlying cause more often than not.What happens if certifiers report terms other than the suggested terms?
If a death certificate reports coronavirus without identifying a specific strain or explicitly specifying that it is not COVID-19, NCHS will ask the states to follow up to verify whether or not the coronavirus was COVID-19. As long as the phrase used indicates the 2019 coronavirus strain, NCHS expects to assign the new code. However, it is preferable and more straightforward for certifiers to use the standard terminology (COVID-19).What happens if the terms reported on the death certificate indicate uncertainty?
If the death certificate reports terms such as “probable COVID-19” or “likely COVID-19,” these terms would be assigned the new ICD code. It Is not likely that NCHS will follow up on these cases. If “pending COVID-19 testing” is reported on the death certificate, this would be considered a pending record. In this scenario, NCHS would expect to receive an updated record, since the code will likely result in R99. In this case, NCHS will ask the states to follow up to verify if test results confirmed that the decedent had COVID19.Do I need to make any changes at the jurisdictional level to accommodate the new ICD code?
Not necessarily, but you will want to confirm that your systems and programs do not behave as if U07.1 is an unknown code.Should “COVID-19” be reported on the death certificate only with a confirmed test?
COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death. Certifiers should include as much detail as possible based on their knowledge of the case, medical records, laboratory testing, etc. If the decedent had other chronic conditions such as COPD or asthma that may have also contributed, these conditions can be reported in Part II. (See attached Guidance for Certifying COVID-19 Deaths)
The memo was issued specifically to personnel working with ICD codes, an area of medical administration with which the public at large has little familiarity. In other words, in the hands of laymen, the ICD direction was removed from its typical context — medical administration.
For instance, the question “What happens if the terms reported on the death certificate indicate uncertainty?” contained instructions about codes likely resulting in “an R99.” “An R99” is unspecified or unknown cause of death, highly relevant information in the context of the claim. That answer explained:
If the death certificate reports terms such as “probable COVID-19” or “likely COVID-19,” these terms would be assigned the new ICD code. It Is not likely that NCHS will follow up on these cases. If “pending COVID-19 testing” is reported on the death certificate, this would be considered a pending record. In this scenario, NCHS would expect to receive an updated record, since the code will likely result in R99. In this case, NCHS will ask the states to follow up to verify if test results confirmed that the decedent had COVID19.
In the very same memo that Bukacek claimed created a new medical code to classify all deaths as COVID-19 based on guesses and rough estimates, NVSS indicated the use of specific codes would cause requests for states to “verify if test results confirmed that the decedent [was diagnosed with] COVID-19.”
That specificity versus ambiguity was again addressed in the memo’s final piece of guidance: “If the decedent had other chronic conditions such as COPD or asthma that may have also contributed, these conditions can be reported in Part II.”
Bukacek pivoted to a purported quote from Division of Vital Statistics National Director Steven Schwartz:
Here’s a quote even more laden with meaning. Steven Schwartz, national director of the Division of Vital Statistics says an answer to the question as stated in the organization’s COVID-19 alert, “Should COVID-19 be reported on the death certificate only with a confirmed test?”
Check out his answer, and I quote from this memo of which I have a copy:
“COVID-19 should be reported on the death certificate for all decedents where the disease caused, or is assumed to have caused, or contributed to death. Certifiers should include as much detail as possible based on their knowledge of the case, medical records, laboratory testing, etc.”
That excerpt was from the memo reproduced above, just above a footer with Schwartz’s contact information. It wasn’t as if those answers were being widely and separately disseminated, and in its proper context, Schwartz was clearly addressing an effort to ensure all contributing cases of COVID-19 were captured as the new ICD code was introduced.
Bukacek, as quoted above, referenced additional unspecified information that she claimed appeared on the Centers for Disease Control and Prevention’s website on April 4 2020:
When it comes to COVID-19 there is the additional data skewer, that is … get this … there is no universal definition of a COVID-19 death. The Centers for Disease Control, updated from yesterday, April 4th [2020], still states that mortality quote unquote data includes both confirmed and presumptive positive cases of COVID-19. That’s from their website.
Without further clarification, it was impossible to say for sure where Bukacek found the quote, and therefore impossible to verify its context. A likely source, however, was a regularly-updated page (“Provisional Death Counts for Coronavirus Disease [COVID-19.]”) We found a copy of the page archived on April 5 2020 which possibly served as the source for that claim.
Both pages, as of April 14 2020, began with an explanation of how COVID-19 deaths were tabulated, and explained why lags in data affected those figures:
The provisional counts for coronavirus disease (COVID-19) deaths are based on a current flow of mortality data in the National Vital Statistics System. National provisional counts include deaths occurring within the 50 states and the District of Columbia that have been received and coded as of the date specified. It is important to note that it can take several weeks for death records to be submitted to National Center for Health Statistics (NCHS), processed, coded, and tabulated. Therefore, the data shown on this page may be incomplete, and will likely not include all deaths that occurred during a given time period, especially for the more recent time periods. Death counts for earlier weeks are continually revised and may increase or decrease as new and updated death certificate data are received from the states by NCHS. COVID-19 death counts shown here may differ from other published sources, as data currently are lagged by an average of 1–2 weeks.
The provisional data presented on this page include the weekly provisional count of deaths in the United States due to COVID-19, deaths from all causes and percent of expected deaths (i.e., number of deaths received over number of deaths expected based on data from previous years), pneumonia deaths (excluding pneumonia deaths involving influenza), and pneumonia deaths involving COVID-19; (a) by week ending date, (b) by age at death, and (c) by specific jurisdictions. Future updates to this release may include additional detail such as demographic characteristics (e.g., sex), additional causes of death (e.g., acute respiratory distress syndrome or other comorbidities), or estimates based on models that account for reporting delays to generate more accurate predicted provisional counts.
In its third paragraph, the introduction explained that data are adjusted, and that pneumonia deaths might present as COVID-19 (or vice versa):
Pneumonia deaths are included to provide context for understanding the completeness of COVID-19 mortality data and related trends. Deaths due to COVID-19 may be misclassified as pneumonia deaths in the absence of positive test results, and pneumonia may appear on death certificates as a comorbid condition. Thus, increases in pneumonia deaths may be an indicator of excess COVID-19-related mortality. Additionally, estimates of completeness for pneumonia deaths may provide context for understanding the lag in reporting for COVID-19 deaths, as it is anticipated that these causes would have similar delays in reporting, processing, and coding. However, it is possible that reporting of COVID-19 mortality may be slower or faster than for other causes of death, and that the delay may change over time. Analyses to better understand and quantify reporting delays for COVID-19 deaths and related causes are underway. The list of causes provided in these tables may expand in future releases as more data are received, and other potentially comorbid conditions are determined.
Nothing in that information described a directive to class any and all deaths to COVID-19 or to say that the coronavirus strain was a cause of death if the patient had contracted it before dying from an unrelated incident — such as getting “hit by a bus.” Further, the NVSS/CDC document noted that the data changed as more details were recorded, and that deaths due to pneumonia or COVID-19 might be adjusted up or down.
Daily tables were followed by a “notes” field, stipulations of which seemed to be aligned with Bukacek’s claims:
NOTE: Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period.
*Data during this period are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.
1 Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1
2 Percent of expected deaths is the number of deaths for all causes for this week in 2020 compared to the average number across the same week in 2017–2019. Previous analyses of 2015–2016 provisional data completeness have found that completeness is lower in the first few weeks following the date of death (7).
3 Pneumonia death counts exclude pneumonia deaths involving influenza.
No versions of the page were archived prior to April 5 2020, and all archives antedated the March 24 2020 memo introducing the new ICD code: U07.1 COVID-19. That code was referenced in the tables’ notes, and indeed referenced “confirmed or presumed” COVID-19.
Nevertheless, the devil was in the details, and Bukacek’s speech advanced the idea the CDC or NVSS was exaggerating the number of deaths deliberately for political purposes.
In fact, the CDC/NVSS specifically stated:
Deaths due to COVID-19 may be misclassified as pneumonia deaths in the absence of positive test results, and pneumonia may appear on death certificates as a comorbid condition. Thus, increases in pneumonia deaths may be an indicator of excess COVID-19-related mortality.
Both the NVSS and the CDC referenced initial ambiguity between pneumonia and COVID-19 deaths pending additional testing, stipulating that at least some data was likely to be revised later. Nothing in that wording suggested non-respiratory causes of death such as accident or injury were being attributed to COVID-19 as the rumors suggested.
To recap, rumors that the CDC or NVSS purposefully directed medical personnel to falsify death certificates and count all deaths as COVID-19 related were amplified by Bukacek’s talk, which was viewed hundreds of thousands of times. Her reference to a memo about ICD codes was out of context, and the memo’s wide availability on the internet meant that users could search the “quote, unquote” portions of her commentary, find the memos on the CDC’s website, and conclude that her decontextualized claims were true. In their full context, it was clear neither the CDC nor NVSS were directing mass-misreporting of unrelated death as COVID-19-related — in actuality, the code simply enabled medical administrations to accurately list COVID-19 as a contributed cause where known or suspected. Unconfirmed cases were, per the memos, likely to be adjusted as more data came in.
- CDC Guidelines Allow Deaths to Be Attributed to COVID-19, Even If They Weren't - Liberty Headlines
- The CDC Confesses to Lying About COVID-19 Death Numbers: The normal rules about reporting deaths have been violated by that city [NY] in the rush to inflate the body count, presumably to steer more taxpayer money to the Big Apple.
- Whistleblower: How CDC Is Manipulating The COVID-19 Death-Toll
- WHISTLEBLOWER: HOW CDC IS MANIPULATING THE COVID-19 DEATH TOLL
- MT Medicaid Fraud Probe Snares “Egg-as-Person” Leader
- New ICD code introduced for COVID-19 deaths
- ICD-10-CM Code R99
- Provisional Death Counts for Coronavirus Disease (COVID-19)
- Provisional Death Counts for Coronavirus Disease (COVID-19) [Archived April 5 2020]