Did Government Subsidies Influence the Reporting of Deaths Attributed to Coronavirus Disease 2019?

Abstract

Background: The first round of Coronavirus Aid Relief and Economic Security (CARES) Act payments were distributed in April of 2020 to offset economic and medical costs incurred by the pandemic. Payments per state varied widely, with rural states often receiving 10–20 times more funding per case than their more urbanized counterparts. After the funds were made available some doctors claimed that they were being pressured to inflate their coronavirus disease 2019 (COVID-19) cases. Methods: All data used in the charts was retrieved from internetaccessible databases of governmental and non-governmental sources. Results: Regression analysis indicates a significant correlation between funding per case and increase in reported COVID deaths per state from 2020 to 2021 (P < 0.01, n = 50). Nearly all deaths attributed to COVID-19
were pneumonia-related, and regression analysis of the states also indicates a robust correlation between pneumonia deaths in 2021 and preexisting health indicators from 2018 (r = −0.77). This correlation becomes much weaker when the same health indicators are compared with  (pre-CARES Act) pneumonia deaths in 2019 (r = −0.37). The stronger correlation of 2021 implies that CARES payments encouraged hospitals to attribute more deaths from pre-existing conditions to COVID-related pneumonia. If we compare weekly pneumonia deaths in 2021–2022 against (pre-COVID) pneumonia deaths reported in 2019, we get five peaks of excess pneumonia deaths between the spring of 2020 and the winter of 2021–2022. The two off-season peaks that occur after CARES payments were made available involve a disproportionate number of deaths under the age of 65. These peaks also coincide with surges in overdose death, and the aforementioned correlation between CARES payments and COVID deaths is significantly higher for 5-year age cohorts for ages 20–44 (n = 5, mean r = 0.49 ± 0.032) versus ages 45–84 (n = 8, mean r = 0.36 ± 0.015) (P < 0.001). Pulmonary complications are a common cause of death in opioid overdose victims and the plausibility that some instances of overdose-driven pneumonia being misattributed to COVID-19 is laid out in the discussion. Conclusion: Regression analysis indicates that nearly all deaths attributed to COVID-19 are pneumonia related and CARES payments are likely to have encouraged hospitals to inflate the number of deaths attributed to COVID-driven pneumonia from 2021 to 2022. It is also plausible that a significant portion of the COVID-19 pneumonia deaths reported in Americans under the age of 65 were in reality, the result of pulmonary complications from drug overdose.