• Elon Musk has suggested that coronavirus death counts in the US are inaccurately high.
  • He criticized the federal government for classifying all coronavirus patient deaths as COVID-19 deaths, regardless of whether an underlying condition was a contributing factor. That’s “misleading to the public” and “a lie,” Musk said.
  • However, the coronavirus is known to make chronic health problems fatal.
  • New York City emergency responders and funeral directors also told Business Insider that, if anything, the state has under-counted COVID-19 deaths.
  • Musk has criticized stay-at-home orders as “fascist,” but copious scientific research shows they save lives. 
  • Visit Business Insider’s homepage for more stories.

Elon Musk is not happy about stay-at-home orders.

During Tesla’s earnings call last week, Musk, the company’s CEO, launched into an expletive-ridden tirade, describing the restrictions as an “outrage.”

“I would call it forcibly imprisoning people in their homes against all their constitutional rights. That’s my opinion, and breaking people’s freedoms in ways that are horrible and wrong and not why people came to America or built this country — what the f—,” he said.

Then, in series of tweets, Musk suggested that US authorities are over-counting COVID-19 deaths, since the federal government classifies the deaths of coronavirus patients as COVID-19 deaths, regardless of any underlying health issues that may have contributed to their passing.

Musk said that was “misleading to the public” and “needs to stop.”

Of course, lockdown orders have hindered Tesla and SpaceX’s abilities to build cars, spaceships, and rockets, and temporarily stymied progress toward Musk’s ultimate goal — populating Mars. Tesla was forced to close its main US car factory in California, which poses a “serious risk” for the business, Musk said. 

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However, scientific research clearly shows such measures save lives by slowing the coronavirus’ spread. What’s more, data on excess deaths and frontline observations from funeral directors and emergency responders in New York City suggest that if anything, the US was at first undercounting deaths.

The challenge and imperative of counting COVID-19 deaths

An FDNY ambulance drives through New York City.

Dave Mosher/Business Insider

Counting the people killed by the coronavirus is no simple task, especially given that many with preexisting conditions are getting sick, lockdowns affect access to medical services, and there’s still not enough diagnostic testing nationwide. 

Given that, Dr. Deborah Birx, the response coordinator for the White House coronavirus task force, recently confirmed that the US would count all coronavirus patient deaths as COVID-19 deaths, even though some countries don’t ascribe to that protocol.

“There are other countries that if you had a pre-existing condition, and let’s say the virus caused you to go to the ICU [intensive care unit] and then have a heart or kidney problem,” she said during an April 7 news briefing. “Some countries are recording that as a heart issue or a kidney issue and not a COVID-19 death.”

The US’s rational for reporting those as COVID-19 deaths is straightforward and sensible: Having a comorbidity, or added risk, often greatly increases the chance a person with COVID-19 will die. Research also increasingly shows the disease impacts more than just our lungs. It can cause blood clots that may lead to strokes and require amputations, even in young, healthy patients. There’s also mounting evidence the virus may harm organs like the heart, kidneys, and the nervous system.

Yet Musk slammed the inclusive approach, tweeting: “Classifying all deaths as corona even if corona didn’t cause the death is simply a lie.” 

Too many excess deaths

Workers move bodies to a refrigerated truck from the Andrew T. Cleckley Funeral Home in the Brooklyn, New York, April 29, 2020.

The pandemic’s carnage is clear in excess deaths numbers, which compare current death rates to historic data. 

Recent analyses by the New York Times and Financial Times lined up several years’ worth of weekly death rates and compared them to 2020’s weekly death rates. The difference between the two suggests the federal government — even with a wide scope of what counts as a COVID-19 death — is significantly undercounting.

Between March 8 and April 11 in New York City, for example, the New York Times reported there were 11,900 excess deaths yet only 10,261 confirmed COVID-19 deaths — a gap of 1,700. New York state (excluding the city) saw a similar gap, with 4,200 excess deaths and 2,425 confirmed COVID-19 deaths. Similar disparities have been reported in other states, including Michigan, Illinois, Massachusetts, Maryland, and Colorado.

A graphic from the Centers for Disease Control and Prevention shows that the share of US deaths due to pneumonia, flu, and COVID-19 spiked sharply beginning in February. By April 11, nearly one-quarter of all deaths in the country were related to one of these three respiratory illnesses.

A graphic showing US death certificates, as a percentage of all deaths in the country, issued for pneumonia, influenza, and COVID-19 from late 2018 through April 24, 2020.

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The trend applies to other countries, too. In the region of Lombardy, Italy, there were 13,000 excess deaths from March through part of April, but 4,348 reported COVID-19 cases.

The higher-than-normal number of excess deaths is almost certainly due to a mix of COVID-19 infections and situations created by the pandemic. Medical examiners interviewed by the Associated Press, for example, cited increases in deaths related to drug overdoses, at-home accidents, and people being afraid to go to the hospital. Calls and texts to suicide hotlines have also increased sharply, and many cancer patients have had elective surgeries delayed or canceled.

However, excess deaths are especially high in places with high rates of COVID-19 cases, such as Italy’s Bergamo province, and lower in regions under lockdown that have seen fewer cases. This suggests the biggest reason for excess deaths is COVID-19, not other risks brought about by lockdowns.

Frontline workers and funeral directors in New York City have also said repeatedly that the number of COVID-19 deaths outside of hospitals was initially undercounted.

The death count ‘does not include the people who are left behind’

Oren Barzilay, the president of the New York Fire Department’s Local 2507 union, told Business Insider in early April that “the numbers that are being reported of deaths does not include the people who are left behind.”

“When the medical examiner gets there, they’re just marking it as ‘natural death’ without testing them,” he explained. “So these numbers are skewed from what’s being reported and what actually is happening. I think if they counted the bodies we leave behind, that number would significantly increase by a few hundred each day.”

New York City has since tweaked its official counts to include probable COVID-19 deaths, drawing the ire of Musk.

“This needs to stop,” he tweeted on April 30, in response to a video posted by a right-wing activist group.

But a New York funeral director whose identity is known to Business Insider but who asked not to be named to avoid retaliation from Musk’s followers, dismissed Musk’s claim as a “conspiracy theory.”

“The issue was they were putting things like ‘community pneumonia,’ ‘probably COVID-19,’ and ‘recent flu-like symptoms,’ and those weren’t being counted in the COVID-19 count,” the funeral director said.

Fixing such underreporting is imperative — not just so US statistics are accurate but also so family members can make final arrangements. 

“When a family wants cremation, we have to submit the death certificate to the medical examiner’s office, they review the cause of death, and they determine if that person can be cremated,” Patrick Marmo, founder and director of International Funeral Service of New York in Brooklyn, told Business Insider in March. “What’s happening is doctors that don’t have confirmed case of COVID, they’re putting ‘pneumonia.’ So now [medical examiners] are not accepting this cause of death. We have to wait to get the right cause of death that would be cleared for cremation.”

Musk says lockdowns are ‘fascist,’ but research shows they save lives

People protest at Washington’s capitol building against the state’s extended stay-at-home order on April 19, 2020.

On the April earnings call, Musk said he didn’t think anyone should be forced to stay at home.

“If somebody wants to stay in their house, that’s great. They should be allowed to stay in their house, and they should not be compelled to leave,” he said, adding, “But to say that they cannot leave their house, and they will be arrested if they do, this is fascist. This is not democratic. This is not freedom. Give people back their goddamn freedom.”

The same day, Musk said in a tweet that “hospitals in California have been half empty this whole time” to support the idea that lockdowns weren’t necessary. But he failed to note that many hospitals aren’t at full capacity precisely because of the effectiveness of lockdowns. He also did not address the fact that many Americans with COVID-19 are dying in their homes because they’re reluctant to visit a hospital.

Overwhelming scientific evidence suggests that lockdowns help contain coronavirus outbreaks and prevent additional deaths.

China, Germany, and Spain all saw their numbers of new daily infections drop after lockdowns went into effect. In Italy, researchers recently simulated what could have happened if the country’s restrictions had been relaxed in March or not imposed at all. The results showed the lockdown prevented around 200,000 hospitalizations between February 21 (when Italy’s first case was reported) and March 25. It also reduced transmission by around 45%.

Staff members remove a barrier at a highway toll station in Wuhan, China, on April 8, 2020.

In Wuhan, China, meanwhile — where the virus was first identified — a recent study found that the city’s lockdown on January 23 prevented tens of thousands of infections. Cases in Hubei would have been 65% higher without such restrictions, the study found. 

Scientists also found that Chinese cities that implemented restrictions before they discovered any COVID-19 cases saw one-third fewer cases during their first week of infections than cities with more delayed responses to the outbreak. Overall in China, researchers have determined that social distancing reduced the number of daily interactions at least sevenfold, thereby lowering transmission. 

“Social distancing provided by the lockdowns has clearly slowed the spread of the virus,” Jeffrey Morris, director of the biostatistics division at the University of Pennsylvania, previously told Business Insider of the US’s stay-at-home measures. He added that lockdowns “ultimately save some lives.”

It’s understandable that business leaders like Musk are itching to reopen. But moving too fast will almost certainly prove deadly.

“If you lift the restriction too soon, a second wave will come, and the damage will be substantial both medically and economically,” Turgay Ayer, a research director for healthcare analytics at Georgia Institute of Technology, told The Daily Beast. “We don’t want to throw away the sacrifices we have made for weeks now.”

Aria Bendix, Rhea Mahbubani, and Morgan McFall-Johnsen contributed reporting to this story.

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