Catastrophic Health Collapse (part 7)

In this article I utilise in-hospital death data for 2017 – 2021 from a sizeable NHS Trust to reveal trends in respiratory & COVID death

Part 5 of this series sets the essential background to this analysis. Before we get stuck in again this morning I ought to mention what is meant by a ‘respiratory death’. As previously stated this not the clear cut definition our minds would like to see. For example, one or more respiratory diagnoses prior to death may be recorded on the patient administration system but the patient may well have died from liver failure. Another layer of complexity comes with the specialist team of clinical coders whose job it is to scour medical notes and code diagnoses, treatments and outcomes to ensure a flow of money into each NHS Trust. Since we’re talking contractual matters then clinical coders tend to speak a different language to medics.

What Does ‘Respiratory’ Mean?

In terms of ICD-10 coded diagnoses for in-hospital deaths involving respiratory illness you’ve got an entire chapter of possible codes: Chapter X (J00-J99) Diseases of the respiratory system. Last time I looked chapter this spanned 452 codes+sub-codes ranging from J00 Acute nasopharyngitis [common cold] to J99 Respiratory disorders in diseases classified elsewhere.  Folk can die with a common cold (J00) or they can die from acute respiratory failure (J96), so we’re looking at death within a very broad spectrum of associated conditions rather than primary unicausal death. Please remember this when eyeballing the tripe served by the ONS.

With the detail offered by ICD-10 coding it is possible to separate acute/severe/life threatening respiratory conditions from chronic/minor. An assumption here is that if somebody is going to die from COVID-19 then they’ll enter an acute respiratory phase at some point. If they don’t enter an acute phase then their case should not really be treated as a symptomatic COVID death. Equally, if somebody suffered from bacterial pneumonia or other non-COVID viral pneumonia then this case should not be treated as symptomatic COVID death. In this way we can separate out those cases deserving of the classification of symptomatic COVID death; that is to say, these are deaths whereby SARS-COV-2 is the one and only pathogen causing an acute respiratory condition leading directly to their demise. All other cases yielding a positive test result are thus coded as asymptomatic COVID.

What Does ‘COVID’ Mean?

This classification is made possible because incidence of COVID-19 is coded specifically within ICD-10 rather than generalised as a respiratory condition. It was primarily coded as U07.1 COVID-19, virus identified and U07.2 COVID-19, virus unidentified under chapter XXII Codes for special purposes rather than under chapter X Diseases of the respiratory system and chapter I Certain infections and parasitic diseases. As if that strategic decision wasn’t weird enough we may note that when SARS v1.0 was on the rampage WHO decided it worthy of two real codes under these very chapters: J12.81 Pneumonia due to SARS-associated coronavirus; B97.21 SARS-associated coronavirus as the cause of diseases classified elsewhere.

Please note that I’ve also carefully used the phrase ‘it was primarily coded as’ because the meaning of COVID-19, like the virus itself, has moved on and mutated. We now have a whole bunch of COVID codes and here’s a screenshot of the 2023 release of ICD-10 codes that refer to the phenomenon:

There’s a lot to think about here but I hope the point is made that COVID is a very slippery customer, which means COVID death will be a very slippery customer. When you squint at data from an authoritarian source you are going to have to go over the small print with a fine tooth-comb. For example, it is entirely possible for an organisation to count deaths under U09.9 Post COVID-19 condition, unspecified. And if you want to make the disease magically proliferate at the press of a mouse start your count using just U07.1 then add in U09.9 and others at the appropriate moment, like the ONS do. You can also play games with vaccinated and unvaccinated COVID death by restricting the coding frame for the former whilst widening it for the later.

Do bear in mind that these codes apply to all folk passing through the medical system, so they can be applied to absolutely anybody - even those going for a routine check-up. Thus, your friendly local physician as well as your big centre surgeon can code ‘vaccine hesitancy’ (Z28.31; Z28.310; Z28.311) following any diagnosis or treatment if they so wished. Anybody who has undergone a stay in hospital may have the clinical coding team doing the same regardless of what the consultant says. Also worth noting at this juncture is that vaccine ‘hesitancy’ is not coded for any other jab on the planet - the powers that be only want to know if you’ve been spiked with synthetic mRNA. To say this is anomalous is an understatement.

The From-and-With Chestnut

Please do bear in mind that even symptomatic COVID death cannot be assumed to be causal. All we may glean in retrospect is that a medical diagnosis of COVID-19 (that may or may not have been supported by a positive test and other diagnostic results) was declared at some point. For example, it is possible to bring a patient back from acute respiratory failure (COVID or not) only to have their liver function collapse or sepsis set in. Then we have bacterial pneumonia doing all the damage in the shadow of a positive test result. Such is the nonsense of primary unicausal death data coded by MUSE, as published by the ONS.

One more thing to note before we look at the slides is that I have based the following analyses on age weighted data (person years at death) - please see part 6 for an explanation).

No doubt somebody will ask if the data for respiratory death includes COVID and the answer is yes, providing each positive-testing death also possessed an appropriate (acute) respiratory diagnosis. Conversely, the time series for asymptomatic COVID death consists of cases that may or may not include chronic respiratory comorbidities such as asthma. Further differentiation of these time series is possible.

Respiratory Death 2017 – 2021

Grey dashed lines have been provided to mark the very beginning of the pandemic, nominally set to 2020/w5 (w/e 31 January 2020), and the very beginning of vaccine rollout during 2020/w50 (w/e 11 January 2021).

If we take acute respiratory death as a proxy measure that would surely mark out the passage of a novel and deadly respiratory virus then we don’t get to see anything much given the absolute fuss that was made of the first wave. In fact, there’s a decline from a peak during December 2019 that picks back up to a moderate hump that is totally in-keeping with historic trends. It is not until 2020/w41 (w/e 9 October 2020) that incidence of acute respiratory death could be construed to be problem of sorts, and even then this autumnal surge might not be anything special if we search back in time before 2017 (the first few data points suggest as much). Arguably, what is more interesting is that peak acute respiratory death occurred six weeks after vaccination rollout began. This may well turn out to be evidence of vaccine harm, though it is impossible to say without digging deeper.

The time series for chronic respiratory death is mighty interesting. Show this to that same Martian and ask them to point out when the pandemic was. My money is on a little green sucker tapping on the 2017/18 winter season.

COVID Death 2020 – 2021

Grey dashed lines have been provided to mark the very beginning of the pandemic, nominally set to 2020/w5 (w/e 31 January 2020) and the very beginning of vaccine rollout during 2020/w50 (w/e 11 January 2021).

Well, well, well. The take home message here surely is the propensity for asymptomatic COVID death during the first wave, these being people who tested positive but never developed an acute respiratory phase. Interesting! A rough rule of thumb suggests three asymptomatic deaths for every symptomatic death. Add symptomatic and asymptomatic together and you’ll end up with a peak of 41.4% total COVID death during 2020/w16 (w/e 17 April 2020).

I can’t help but think that NHS staff may well have thought they were knee deep in COVID death when they were merely knee deep in non-respiratory death that got tagged as COVID following a positive test result that tells us nothing about infection and, in fact, nothing about viral presence (a primer sequence is not a genome).

It is interesting to note just how different things were for the second and third wave when, for every symptomatic COVID death, there was an asymptomatic COVID death. I’d sure like to get my hands on the casenotes because I’d bet good money that what we’re calling asymptomatic COVID deaths are deaths from other causes that were labelled such simply because of a single positive test result rather than the considered diagnosis of an experienced medic unfettered by WHO and NHS protocols. In this regard I’ve had three NHS clinical coders confide they they were instructed by management to code a case as COVID even through Senior House Officers were writing ‘NOT COVID’ across casenotes. It is a shame we can’t offer job protection for whistle-blowers like these, but even if we could a big problem lies with the fascist views and aggressive attitudes of colleagues. Several healthcare professionals have provided me with reports of utterly shameful behaviour of senior staff when they’ve tried to raise genuine concerns: I no longer recognise the service in which I once served.

So, then, if vaccines were efficacious as claimed then why do we see a peak in symptomatic COVID death 6 weeks after rollout began? And why does symptomatic COVID death mirror asymptomatic COVID death in the vaccine era, shouldn’t these curves diverge? Looking at this slide I can only conclude vaccine efficacy is also an illusion.

Kettle On!