Biden Got the Coronavirus Death Toll Wrong | Opinion

On Tuesday night, in his first debate with President Donald Trump, Joe Biden claimed "200,000 dead, 7 million infected [with the coronavirus] in the United States. We have 5 percent, 4 percent of the world population; 20 percent of the deaths."

It is a theme that Biden has repeatedly raised. But it isn't true. It is better than his typical approach of not accounting for the population's size in the United States relative to other countries. But it ignores the unreliable COVID-19 data from other large countries, most notably China and Russia, which have underreported infections and deaths. More importantly, Biden's claim doesn't acknowledge that the U.S. counts coronavirus deaths differently from other countries. Indeed, we are counting deaths differently than we have for any other disease.

"The case definition is very simplistic," Dr. Ngozi Ezike, director of Illinois Department of Public Health, explains. "It means, at the time of death, it was a COVID positive diagnosis. That means, that if you were in hospice and had already been given a few weeks to live, and then you also were found to have COVID, that would be counted as a COVID death. It means, technically even if you died of [a] clear alternative cause, but you had COVID at the same time, it's still listed as a COVID death."

The CDC currently puts the number of confirmed coronavirus deaths at 204,000. But even the "best estimate" 0.26 percent fatality rate is a significant overestimate because of how the CDC counts deaths. And though public health officials have been transparent about how they are counting coronavirus deaths, the implications for calculating the infection fatality rate often go unstated.

Medical examiners from Colorado to Michigan use the same definition Ezike described. In Macomb and Oakland Counties in Michigan, where most of the deaths in that state occurred, medical examiners classify any death as a coronavirus death when the postmortem test is positive. Even people who died in suicides and automobile accidents meet that definition.

Such expansive definitions are not the fault of rogue public health officials. The rules direct them to do this. "If someone dies with COVID-19, we are counting that as a COVID-19 death," White House coronavirus response coordinator Dr. Deborah Birx noted multiple times.

A respiratory therapist walks into a COVID-19 patient's room in the ICU at Oakbend Medical Center in Richmond, Texas, on July 15, 2020. Mark Felix/AFP/Getty

Beyond including people with the virus who clearly didn't die from it, the numbers are inflated by counting people who weren't even infected. New York has classified many cases as coronavirus deaths even when postmortem tests have been negative. The diagnosis can be based on symptoms, which are often similar to those of the seasonal flu.

The Centers for Disease Control guidance acknowledges the uncertainty that doctors face when identifying causes of death. When coronavirus cases are "suspected," the agency counsels doctors that "it is acceptable to report COVID-19 on a death certificate." This advice has produced a predictable inflation in the numbers. On April 21, when New York City's death toll rose above 10,000, The New York Times reported that the city included "3,700 additional people who were presumed to have died of the coronavirus but had never tested positive"—a more than 50 percent increase in the number of cases.

Nor can this be explained by false-negative results in the tests. For the five most commonly used tests, the least reliable test still scored a 96 percent accuracy rate in laboratory settings. Some doctors report feeling pressure from hospitals to list deaths as coronavirus deaths, even when they don't believe COVID-19 is the true cause, "to make it look a little bit worse than it is." They said they never faced such pressure in reporting deaths from the seasonal flu.

There are financial incentives for doctors and hospitals to report deaths this way. The CARES Act adds a 20 percent premium for COVID-19 Medicare patients. Birx and others are also concerned that the CDC's "antiquated" accounting system is double counting cases and inflating mortality and case counts "by as much as 25 percent." When all these anomalies are added up, it becomes apparent that we simply don't have an accurate coronavirus death toll. But it seems clear that at least two-thirds of the reported fatalities are actually due to causes other than the coronavirus.

Meanwhile, The Washington Post, New York Times and others claim that we are undercounting the true number of deaths. They reach that conclusion by pointing to the fact that the total number of deaths from all causes was about 30 percent greater than we would typically expect from March through early May. They then conclude that the excess is due to deaths not being accurately labeled as coronavirus fatalities.

But these are not normal times. Many people with heart problems aren't going to the hospital for fear of the virus. Delaying cancer surgeries and other serious medical treatments for months has real impacts on life expectancies. The stress of the situation is almost certainly increasing suicides and other illnesses. This is not to minimize the direct threat coronavirus poses: Even if the true death toll is closer to 60,000 than 200,000, this pandemic is a big deal. But we need some perspective. During the 2017-18 flu season, 61,000 Americans died from the flu.

The number of cases is also greatly exaggerated, with many states counting the number of positive tests rather than the number of individuals with the virus. In July, found that about half the states were reporting "tests in units of specimens (tests) rather than individuals (people tested)." This is a problem because, if someone is in the hospital for a couple of weeks, he or she might be tested daily.

All these data problems make it very difficult to determine how the U.S. is doing relative to other countries or even relative to other diseases. But the media should at the very least demand that Biden put things in per capita rates.

Joe Biden may get some political mileage from misrepresenting the coronavirus death numbers, but exaggerating the problem also causes harm. The lack of fact-checking on Biden's claims is disturbing. The false claims keep businesses shut down and people from going to hospitals when they need help. It increases suicides. Inflated numbers mislead people and cause them to make mistakes.

Timothy Allen is a governor of the College of American Pathologists and chairs the of the Department of Pathology at the University of Mississippi Medical Center. John Lott is the president of the Crime Prevention Research Center.

The views expressed in this article are the writers' own.