PragerU video contains misleading claims about COVID-19 deaths, falsely claims 94% of COVID-19 deaths had pre-existing conditions

A video published by PragerU on Instagram, titled “How many Americans have died from COVID-19?” shows interviews with various people, purportedly to determine whether “everyday Americans have an accurate perception of COVID-19.” The video, which received more than 200,000 views, contains several claims about deaths during the COVID-19 pandemic, including some which have already been debunked.

Overall, the underlying message of the video is that the COVID-19 pandemic is not dangerous, and therefore measures such as the wearing of face masks and lockdowns are excessive. The video bases its claims on statistics valid only on 4 September 2020, despite being published in late December 2020, which paints a highly misleading picture of the current situation in the U.S.

Claim 1 (Inaccurate):

“only 6% of COVID-19 deaths were caused by COVID-19 just alone”; “all the other 94% of people had preexisting conditions before”

The video gives airtime to an already-debunked claim that only a small minority of COVID-19 deaths (6%) were actually from COVID-19 alone and that the rest died from their “preexisting conditions.” This is false. As explained in an earlier review by Health Feedback, this claim is based on an inaccurate interpretation of how deaths are recorded in death certificates.

Firstly, deaths are not classified as “COVID-19 deaths” merely because the disease is confirmed or suspected. Instead, the clinical evolution of the patient has to be compatible with the course of the disease to be classified as a death from COVID-19. World Health Organization (WHO) guidelines also state that “Persons with COVID-19 may die of other diseases or accidents, such cases are not deaths due to COVID-19 and should not be certified as such.” For instance, a patient whose death certificate lists cancer as a cause of death would have presented clinical signs and symptoms consistent with cancer, not with COVID-19. Such a patient would not be reported as a COVID-19 death even if they died of cancer and were infected with COVID-19 at the time of death.

Secondly, it is inaccurate to claim that all 94% of deaths with comorbidities had preexisting conditions. Some comorbidities, such as diabetes, are indeed preexisting conditions. However, others, such as respiratory failure, may be a consequence of COVID-19 itself, although not directly involved in the sequence of clinical events leading to death.

As Justin Lessler, an infectious disease specialist at Johns Hopkins University’s Bloomberg School of Public Health, explains in an article published by the university’s Office of Communications, some comorbidities are actually downstream of COVID-19, such as respiratory failure. In this example, the patient’s death would still be solely due to COVID-19, even though the comorbidity of respiratory failure is listed on the death certificate. In other words, the claim ignores the fact that people among the 94% have comorbidities that arose solely as a result of COVID-19 and were not pre-existing conditions. Therefore the cause of death remains the same—COVID-19.

Claim 2 (Lacks context):

0.056% of Americans have died from COVID-19

The interviewer Will Witt claims that of the “350 million Americans,” just 0.056% have died from COVID-19. (The most recent figures from the U.S. Census Bureau indicates that the U.S. population is actually about 328 million.) The latest number of COVID-19 deaths reported by the U.S. Centers for Disease Control and Prevention is 318,569, giving a percentage of about 0.097%, so the figure given in the video is not accurate anymore.

However, this manner of calculating mortality rate is highly misleading as mortality rate from an infection is only calculated from among people who have had the infection. The infection mortality rate (IFR) for COVID-19, which reflects the proportion of deaths among all infections, is estimated at approximately 0.68%^[1]. As a point of reference, the IFR of seasonal flu has been estimated at about 0.04%. This puts the IFR of COVID-19 at more than 10 times higher than that of the flu.

Furthermore, the number of deaths occurring in the U.S. during the COVID-19 has exceeded the average number of deaths from previous years (excess death). In fact, more than 300,000 excess deaths have been recorded so far. About 200,000 have been directly attributed to COVID-19 and about 100,000 are attributed to indirect causes, such as delay in seeking medical treatment for other illnesses^[2]. This is one of the clearest indications that the pandemic is indeed claiming many more lives than usual. The cited figure of 0.056% fails to capture the extent of the damage caused by the pandemic.

Finally, the focus on mortality alone ignores the fact that a proportion of COVID-19 survivors go on to develop potentially persistent health problems, like neurological deficits, that can affect their ability to function in everyday life, as has been reported by Science here and here, Nature, and BBC. This subject was also covered in a previous Health Feedback review. The best way to avoid such long-term health problems from developing in a population is to prevent COVID-19 infection in the first place. Short of a vaccine, this can be achieved by following public health guidance, such as wearing face masks and physical distancing.

Claim 3 (Misleading):

Hospitals have an “incentive to count deaths as COVID-19 deaths so they get more funding”

This claim implies that hospitals have been deliberately padding their COVID-19 death counts for financial gain, and has also been echoed by U.S. President Donald Trump. This claim has been evaluated by other fact-checkers, such as PolitiFact and FactCheck.org.

PolitiFact explained:

“Hospitals get an extra 20% for Medicare patients being treated for COVID-19. This was part of a coronavirus relief bill Trump himself signed on March 27, 2020. Medicare (which covers about 40% of all hospital patients) provides a flat rate payment based on the patient’s diagnosis, and the CARES act included additional payment to address the complications and costs that typically accompany COVID-19 patients.”

However, there is no evidence supporting the implication that hospitals are inflating their COVID-19 cases or deaths for monetary gain. Clinical ethicist Julie Aultman, who is a member of the editorial board of the American Medical Association’s AMA Journal of Ethics, told PolitiFact “There are strict policies for reporting and, quite frankly, healthcare workers are only focusing on helping their patients and doing as much as they can with little resources.”

The implication that cases are inflated is also contradicted by the number of deaths observed during the pandemic, as well as ICU bed occupancy levels. This New York Times article published on 9 December 2020 reported:

“Survival rates from the disease have improved as doctors have learned which treatments work. But hospital shortages could reverse those gains, risking the possibility of increasing mortality rates once again as patients cannot receive the level of care they need.

Thomas Tsai, an assistant professor of health policy at Harvard University, said that when resources are critically constrained, healthcare workers already facing burnout are forced to make emotionally wrenching decisions about who receives care.”

Indeed, an NPR news report published on 20 December 2020 stated that hospitals in California are “now stretched to their limits as intensive care units fill up and COVID-19 cases continue to soar, leaving some facilities facing the prospect of not being able to provide critical care for everyone who needs it.”

It also added:

“Some hospitals are now preparing for the possibility of rationing care in the coming weeks, according [to] a document obtained by the Los Angeles Times. The document, which was circulated among doctors at four hospitals run by Los Angeles County, outlined guidelines on how to allocate resources in a crisis situation, shifting from a goal of trying to save every patient to instead saving as many as possible. This would mean that those less likely to survive would not receive the same care that they would in a non-crisis situation.”

This is likely to have an adverse effect on the level of care that both COVID-19 and non-COVID-19 patients will receive.

In summary, many hospitals are facing ICU bed shortages and more than 200,000 excess deaths in the U.S. have been recorded in 2020 so far. These observations are incompatible with the claim that COVID-19 cases and deaths are simply being inflated, and with the implication that COVID-19 is not a serious concern, as suggested by the video. Fictitious cases or an illness that is not serious would not lead to ICU beds filling up or more overall deaths than usual occurring.

Additional Notes

During the interview, one individual who identified themselves as a nurse claimed that intensive care unit (ICU) beds in Indiana were “never full” and that they felt the situation “could be overexaggerated a little bit.”

The Indiana COVID-19 Dashboard and Map does indeed show that, so far, ICU bed capacity has not been completely taken up yet. However, this is certainly not the case for other states in the U.S. As mentioned above, many other states in the U.S. are seeing their hospitals’ ICU capacity fill up to the extent that healthcare workers are preparing to ration care due to insufficient resources.

REFERENCES

• 1 – Meyerowitz-Katz and Merone. (2020) A systematic review and meta-analysis of published research data on COVID-19 infection fatality rates. International Journal of Infectious Diseases.
• 2 – Rossen et al. (2020) Excess Deaths Associated with COVID-19, by Age and Race and Ethnicity — United States, January 26–October 3, 2020. Mortality and Morbidity Weekly Report.