For 15 months, the data regarding COVID-19 illness, hospitalizations, and deaths have been suspect. This statement does not mean COVID-19 does not exist or that some people who contracted it did not suffer from severe illness and die from it. However, the prepositions, with, for, and of are critical qualifiers in tracking the actual impacts of COVID-19. A new study from California admits as much.
The reported number of COVID-19 hospitalizations, one of the primary metrics for tracking the severity of the coronavirus pandemic, was grossly inflated for children in California hospitals, two research papers published Wednesday concluded. The papers, both published in the journal Hospital Pediatrics, found that pediatric hospitalizations for COVID-19 were overcounted by at least 40 percent, carrying potential implications for nationwide figures.
Color me shocked. At the beginning of the pandemic, the government and insurers put several policies in place that made sense to determine disease prevalence, which included widespread testing. Hospitals correctly did preemptive testing to determine the correct infection control protocols to use with individual patients. However, other mandates paired this with perverse financial incentives that provided additional funding for COVID-19 care. The original COVID-19 relief package created a 20% premium that included probable cases and laboratory-confirmed cases for Medicare patients. Several large health insurers also waived copays and coinsurance for care related to COVID-19.
The motives for these reimbursement policies were, in all probability, principled. Hospitals were shut down for many elective and non-emergency procedures, reducing their income. The cost of care for severe COVID-19 in an intensive care unit is also extraordinary. Trying to preserve the health system and insulate families from crippling medical costs was undoubtedly noble. However, being in the hospital with COVID-19 and being in the hospital for COVID-19 are two completely different situations and the reimbursement policies made no distinction.
Let me explain. If a 50-year-old male is admitted to the hospital with chest pain, the staff will test him for COVID-19 per hospital policy. If his test is positive, even with no COVID symptoms, COVID-19 will, in all likelihood, be added to his diagnosis. Yet, if he has a heart catheterization and a blockage in a coronary artery is detected and corrected, the reimbursement will still kick in. Even if he never had a clinical symptom of COVID-19.
This situation became problematic and turned into a perverse incentive once we understood the number of people who would remain asymptomatic and test positive and the PCR test’s ability to detect the target genes of the test in recovered patients for three months. Combine large numbers of people who may not be aware they were ever exposed to the virus and had an immune reaction, with the sensitivity of the tests in detecting what is essentially harmless viral debris for three months. The government and insurers should have implemented requirements for lab-confirmed COVID-19 and clinical symptoms for reimbursement at that time.
How can we be sure? The answer is in the study review:
Kushner et al conducted an extensive chart review of 117 pediatric hospitalizations with a positive SARS-CoV-2 PCR from May 10, 2020 to February 10, 2021 at a quaternary care academic children’s hospital In Northern California. Study authors used a set of pre-determined criteria to characterize each hospitalization as either “likely” or “unlikely” for COVID-19 disease. They found that 53 hospitalizations (45%) were unlikely to be due to disease caused by SARS-CoV-2. Rather, patients were hospitalized for a wide range of other diagnoses, including bacterial infections, scheduled surgical procedures, appendicitis, ingestions, anaphylaxis, and neurologic conditions. Of the 64 patients who were likely to have been hospitalized for COVID19, 3 were asymptomatic and 27 had mild to moderate symptoms, with 20 characterized as either severe or critical (the remaining 14 were diagnosed with MIS-C).
A second study cited using a similar method in California found 40% of the children were hospitalized for a reason other than COVID-19 and never demonstrated symptoms of the virus. These findings led the author to conclude:
Taken together, these studies underscore the importance of clearly distinguishing between children hospitalized with SARS-CoV-2 found on universal testing versus those hospitalized for COVID-19 disease. Both demonstrate that reported hospitalization rates greatly overestimate the true burden of COVID-19 disease in children.
The situation would be no different in adults in an honest audit. It also extrapolates to deaths. Undoubtedly, some people died solely due to the chain of immune system reactions that lead to severe respiratory distress and organ failure that are the hallmarks of late-stage COVID-19 infection. However, one study last November found that in three New Jersey hospitals, 89% of those listed as COVID-19 deaths had Do-Not-Resuscitate (DNR) orders before being diagnosed with COVID-19.
A doctor makes a DNR order to prohibit life-sustaining treatment such as mechanical ventilation, CPR, and feeding tubes. Often this order is made in consultation with the patient and the family. In general, they indicate an individual is terminally ill or so frail that the quality of life maintained by these measures is not beneficial. It is highly likely some of the patients this study identified died with COVID-19 rather than of COVID. For others, it mirrors end-of-life processes where catching pneumonia or another infection, such as a urinary tract infection, is an insult that an already weakened immune system cannot clear. These infections progress to respiratory failure, sepsis, and other organ failures which are fatal.
Public health bureaucrats’ failure to distinguish between being hospitalized with or for COVID-19 and dying with or of the virus undoubtedly cost taxpayers billions of dollars in reimbursement. These statistics were also used on particular cable news channels to stoke panic, extend draconian mitigation methods, and as a political cudgel. When communicating medical information to the public, being accurate and precise should be a top priority, and these distinctions were evident early in the pandemic. Americans should demand the so-called experts correct the record immediately.
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