Health Canada/Provinces Goof 8. Hospitalization - 'With' or 'Due' to COVID
It takes 2 years to figure this out?
I am bemused by the apparent interest NOW (after 2 years) to try to determine whether someone was admitted because of a COVID illness or simply with COVID. I never believed any of the information that was being propagandized as it was ridiculous. Anyone with experience in the hospital would know this was not reliable.
The higher number of hospitalizations (always without denominators or information on the number of beds available) with COVID involved the greater the ability to stoke fear. And that is what it was all about. What ethical person in health care would use fear to further their agenda?
I admit I don’t really understand the inner workings of the legal, insurance or financial institutions. How would I? I don’t work there. The vast, vast majority of people who spout health care data in conversations or in the MSM also have no idea what they are talking about.
Here are a few things to consider:
Patients are typically seen in the ED with an illness and then admitted to hospital under a specific service - so for example, a patient that has symptoms that might represent ‘heart failure’ (among many other possible diagnoses) might be seen be either cardiology or internal medicine. The admitting physician will then admit the patient under that service with a diagnosis of ‘heart failure’. Keep in mind this diagnosis is based on a minimal amount of information as not all diagnostic tests are immediately available in the ED (and this will vary markedly between hospitals). As such this diagnosis is: a) necessary for admission as something has to be recorded and b) a good ‘guess’ what the problem might be - and it will change over the course of the admission as more data are accumulated.
During the COVID era patients in the ED will typically have a nasal swab done for COVID. If not done in the ED, then the nurses on the ward will have to do this. The COVID PCR tests are reported faster than out in the outside labs (can take 2 - 3 days) as the laboratories in larger hospitals work 24 hours a day (not necessarily for all tests that are ordered). As such, the COVID responses are faster - let’s say 12 to 24 hours.
In the meantime, and while awaiting the results of the COVID test, the patient is treated as IF they do have COVID - ie. gowns, masks, and gloves (i.e. PPE) by the staff. These policies are eased if the test comes back negative and continued otherwise if positive or perhaps inconclusive. Therefore, it would almost be as if at the time of admission ALL patients have COVID and then this percentage is winnowed down as the COVID test results come back.
COVID PCR tests are not 100% sensitive nor specific. As such there will be false results (positive and negative) as they don’t identify an active infection but remnants of certain parts of the spike proteins (some of which have mutated). Keep in mind that once you have had a true infection the PCR test can remain ‘positive’ for months - this makes trying to interpret a ‘positive’ test very difficult. Are they actively infected, is this a false positive, did they have an infection at some point in the past few months? The differences between these are pivotal, but seem to have been obscured on purpose for the first 2 years. As the prevalence of active COVID INFECTIONS in the population at any one time is low - there will be a substantial percentage of tests that are falsely positive. I will be discussing why this occurs soon - warning some math involved.
At the time of discharge (which would include death) from hospital a final diagnosis will be recorded along with important co-morbidities. This is on a front sheet on the chart. At this point the admitting diagnosis is irrelevant as the clinical picture crystallizes and more information has been gathered. Often a formal dictated or computer generated discharge summary will be constructed for other physicians and health care providers involved in the care of the patient.
Then the chart does down to medical records - a team of their staff goes through each chart with a fine-toothed comb to review, abstract and code the various clinical and laboratory data. The traditional roles of these data were to monitor health services utilization and to assess health services needs for administrative purposes. More recently, however, this administrative data is being used by health services and population health researchers to study health care outcomes, effectiveness, appropriateness and utilization of health care services, and to investigate or monitor population health status and its determinants. During the COVID era the coders used the following: “A confirmed COVID-19 case is one that is diagnosed based on a positive COVID-19 lab test result. It is classified to ICD-10-CA emergency use code U07.1 COVID-19, virus identified. A suspected COVID-19 case is one that is clinically or epidemiologically diagnosed but for which COVID-19 lab test results are inconclusive, not available or testing is not performed. It is classified to ICD-10-CA emergency use code U07.2 COVID-19, virus not identified.”
There are a couple of nuances. First, the importance of the diagnosis of COVID can become the primary diagnostic entity by the coder. For example in one situation they discuss the following: “The patient presents with a cough, fever and shortness of breath. A COVID-19 nasopharyngeal swab is taken. The COVID-19 lab test result comes back positive. The patient also has chronic obstructive pulmonary disease (COPD). The patient is treated with antibiotics and corticosteroids. Over the course of 7 days, the patient’s cough, fever and shortness of breath resolve. The patient is discharged home.” Lab-confirmed COVID-19 is classified and qualifies as the most responsible diagnosis (i.e., COVID-19 pneumonia). This is a common enough scenario. Note the patient was not treated for anything for COVID and improved with antibiotics and steroids. Prior to the COVID pandemic it would likely be assumed this was either due to a bacterial infection or one of the many viruses that were not tested for. Therefore, COVID has become a new diagnosis. It is possible that the attending physician did not think COVID was important and placed it as possible contributing factor. It doesn’t matter as the coder wins. Second, COVID might have nothing to do with the presentation - for example a fall in an elderly lady with a fractured hip - and yet a positive COVID test will now loom large.
Bottom Line: For all of these reasons I would take the data about people admitted with or due to COVID, or dying because of COVID, with a grain of salt. It seems to me to have been due to a deliberate to scare the public and make it seems as if the health care system was in crisis. As with most things during the pandemic - it is not COVID itself which caused the problems, as it is neutral, but the human response and abreaction to it. The health care elites go to great lengths not to blame themselves.