Let’s be real. When I checked in at Ascension in Franklin I had covid, double pneumonia, and sepsis. Any one of them could have been a killer. If not for the grace of God and an amazing support group I believe I surely would have been a goner.

And how would my official cause of death been noted? That’s a critical question because a well-known Covid expert is warning that hospitals may be overcounting COVID deaths, potentially misleading the public and undermining the perception of coronavirus vaccines.

Leana Wen is a professor of health policy and management at the George Washington University Milken Institute School of Public Health, a nonresident senior fellow at the Brookings Institution and author of the recent book “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

Wen wrote an op-ed in the Washington Post late last week where she asked:

According to the Centers for Disease Control and Prevention, the United States is experiencing around 400 covid deaths every day. At that rate, there would be nearly 150,000 deaths a year. But are these Americans dying from covid or with covid?

Understanding this distinction is crucial to putting the continuing toll of the coronavirus into perspective. Determining how likely it is an infection will result in hospitalization or death helps people weigh their own risk. It also enables health officials to assess when vaccine effectiveness wanes and future rounds of boosters are needed.

Wen spoke with two infectious-disease experts who told her they believe that the number of deaths attributed to covid is far greater than the actual number of people dying from covid. 

Robin Dretler, an attending physician at Emory Decatur Hospital estimates that at his hospital, 90 percent of patients diagnosed with covid are actually in the hospital for some other illness.

“Since every hospitalized patient gets tested for covid, many are incidentally positive,” he said.

Wen wrote, “A gunshot victim or someone who had a heart attack, for example, could test positive for the virus, but the infection has no bearing on why they sought medical care. Dretler also sees patients with multiple concurrent infections.”

“People who have very low white blood cell counts from chemotherapy might be admitted because of bacterial pneumonia or foot gangrene. They may also have covid, but covid is not the main reason why they’re so sick,” said Dretler.

“If these patients die, covid might get added to their death certificate along with the other diagnoses. But the coronavirus was not the primary contributor to their death and often played no role at all,” writes Wen.

Dretler told Wen he doesn’t buy at all into the conspiracy theory that medical facilities are exaggerating covid fatality numbers. However…

“Inadvertently overstating risk can make the anxious more anxious and the skeptical more skeptical, Dretler said.

Shila Doron, the chief infection control officer at Tufts Medical Center also spoke to Wen about how she and some colleagues reviewed medical records of covid patients and found that use of the steroid dexamethasone, a standard treatment for covid patients with low oxygen levels, was a good measure for hospitalizations due to the coronavirus. If someone who tested positive didn’t receive dexamethasone during their inpatient stay, they were probably in the hospital for a different cause.

The work done by Doron and fellow researchers led Massachusetts to change its hospitalization reporting ago to include both total hospitalizations with covid and those that received dexamethasone. In recent months, only about 30 percent of total hospitalizations with covid were primarily attributed to the virus.

Determining the true number of hospitalizations from covid “allows for better forecasting of hospital capacity,” Doron told Wen. “If our hospital beds are full and we attribute it to covid, we might think that we’ll get the beds back when the wave of infections is over. But if people are sick from other causes, the beds could stay full.” Wen says both Dretler and Doron are not diminished the severity of covid.

“They have taken care of covid patients throughout the pandemic and have seen the evolution of the disease. Earlier on, covid pneumonia often killed otherwise healthy people. Today, most patients in their hospitals carrying the coronavirus are there for another reason. They want the public to see what they’re seeing, because, as Doron says, ‘overcounting covid deaths undermines people’s sense of security and the efficacy of vaccines’.”

Wen adds, “To be clear, if the covid death count turns out to be 30 percent of what’s currently reported, that’s still unacceptably high. But that knowledge could help people better gauge the risks of traveling, indoor dining and activities they have yet to resume. Most importantly, knowing who exactly is dying from covid can help us identify who is truly vulnerable. These are the patients we need to protect through better vaccines and treatments.”