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The Vicious Circle of Covid Boondoggles and Bad Data

Do you mean to tell me that the CDC, our public health system and Big Pharma have played me for a fool? No, I refuse to believe it!

Is this supposed to be like the Big Acid companies!

The Vicious Circle of Covid Boondoggles and Bad Data

Medicare bonuses and FEMA funeral benefits create incentives to overstate the disease’s toll.

By Leslie Bienen and Margery Smelkinson, WSJ

Jan. 26, 2023 12:52 pm ET

Public-health experts are increasingly acknowledging what has long been obvious: America is overcounting hospitalizations and deaths from Covid-19. Hospital patients are routinely tested for Covid on admission, then counted as “Covid hospitalizations” even if they’re asymptomatic. When patients die, Leana Wen notes in a Washington Post column, Covid is often listed on their death certificates even if it played no part in killing them. Government programs create incentives to overestimate Covid’s toll, and poor data make it difficult to pinpoint who’s still at risk and how effective boosters are.

To the Centers for Disease Control and Prevention, a positive Covid test is enough to identify a “Covid hospitalization.” A few states and hospital systems have taken it on themselves to analyze their hospitalization data more thoroughly. Massachusetts requires hospitals to report how many of their Covid-positive patients have received dexamethasone, a standard treatment for Covid-induced lung inflammation. Using this method, the proportion of Covid-positive patients hospitalized for their Covid symptoms is around 30%, though it fluctuates.

The UC San Francisco hospital system uses remdesivir, a Covid-19 antiviral, as a similar proxy. That yields higher numbers, since remdesivir is given to patients with milder symptoms. UCSF doesn’t report detailed data publicly, but hospitalizations “from” Covid are typically less than half of Covid-positive patients. When the CDC reports data from states, it ignores these efforts to discern which hospitalizations were actually caused by Covid.

The CDC Data Tracker also uses state-generated data in reporting hundreds of daily Covid deaths. Many states report a “Covid death” anytime the decedent had a positive PCR test in the month or two before dying. The National Center for Health Statistics, a CDC subdivision, uses death certificates, which are more reliable. But death certificates have problems of their own, in part because government policies create incentives to overcount.

Under the federal public-health emergency, which begins its fourth year on Friday, hospitals get a 20% bonus for treating Medicare patients diagnosed with Covid-19. That made sense at the beginning of the pandemic, when hospitals were swamped with seriously ill patients, subjected to arduous protocols and losing money from canceled elective procedures. It’s irrational under current circumstances.

Hospitals are under no obligation to test all admitted patients, and CDC guidance on the question is ambiguous. They should end routine testing for Covid and test only those patients who are admitted for respiratory illness for whom a Covid-19 diagnosis would guide treatment. Withdrawing the financial incentive to test would speed up this process.

Another incentive to overcount comes from the American Rescue Plan of 2021, which authorizes the Federal Emergency Management Agency to pay Covid-19 death benefits for funeral services, cremation, caskets, travel and a host of other expenses. The benefit is worth as much as $9,000 a person or $35,000 a family if multiple members die. By the end of 2022, FEMA had paid nearly $2.9 billion in Covid-19 death expenses.

Funeral homes, mortuaries and state health departments widely advertise this benefit on their websites, as does FEMA. By contrast, the agency barely advertises funeral assistance to hurricane victims. And while around 80% of requests for Covid death benefits had been approved as of Jan. 1, some 80% of applications following hurricanes Harvey, Irma and Maria in 2017 were denied. FEMA offers no death benefit for the flu, HIV or any other infectious disease.

Several physicians told us they are concerned that hospitals are being pressured by families to list Covid-19 on the death certificate. “Just try and leave Covid off the death certificate of a person who was asymptomatic positive and died in a car accident,” one infectious-disease doctor said. “Just try.” No one was willing to be quoted by name—unsurprisingly, since the implication is that their hospitals are falsifying death certificates.

These programs create a vicious circle. They establish incentives to overstate the danger of Covid. The overstatement provides a justification to continue the state of emergency, which keeps the perverse incentives going. With effective vaccines and treatments widely available, and an infection fatality rate on par with flu, it’s past time to recognize that Covid is no longer an emergency requiring special policies.

Dr. Bienen is a veterinarian who conducts research on zoonotic diseases and public-health policy. Ms. Smelkinson is an infectious-disease scientist whose research has focused on influenza and SARS-CoV-2. Jeanne Noble, director of Covid response for the UCSF emergency department, contributed to this article.

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