During the coronavirus update briefing yesterday, Dr. Deborah Birx was asked by a reporter how the number of deaths attributed to the virus were being determined.  Her response was that "irrespective of any underlying chronic or acute condition a patient might have had at the time, if the patient tested positive for the virus at time of death, it was considered a coronavirus death."

In other words, if a patient had a stage 4 cancer, advanced COPD, renal failure, or other life-compromising conditions on admittance to hospital and subsequently died, his death was attributed to COVID-19 if he tested positive for the virus, even if he was asymptomatic.

Why does this matter?  It matters because, given the drastic measures we're taking to combat and control the virus, it's vital to know its real, discrete, epidemiological impact, a perspective we cannot get by relying on a statistic blended with other causative factors.

As a baseline reference, the documented average daily death rate in the U.S. from all causes is around 7,400 per day.  As of April 9, 2020, the CDC reports the U.S. has experienced 14,800 deaths attributed to the coronavirus over the preceding four months, roughly two days of the average national daily death rate.  Based on these numbers, this is hardly the existential crisis we've been led to believe it is.  How do we reconcile this non sequitur?

At minimum, three questions need to be answered before we can accurately understand this virus's real morbidity and mortality, and then use these data to make informed decisions as to when we can return to life and business as "normal" (note: questions assume that the patient tested positive for coronavirus premortem):

1. How many deaths have been caused by the coronavirus in patients with no underlying chronic medical conditions at time of death?

2. How many deaths have occurred in patients with underlying chronic medical conditions that have been classified as death by the coronavirus, even though the patient was asymptomatic at time of death?

3. How many deaths have occurred in patients with underlying chronic medical conditions that have been classified as death by the coronavirus, where the patient was symptomatic, and COVID-19 was clearly a contributing factor at time of death?

Only with these questions answered can the real impact of the virus be ascertained.