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. 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. Excerpts:

"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"

"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."

"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."

"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."

"Several physicians told us they are concerned that hospitals are being pressured by families to list Covid-19 on the death certificate."