During Tuesday’s White House press briefing, coronavirus task force leader Dr. Deborah Birx explained that COVID-19 deaths in the United States have “very liberal” recording guidance, noting that anyone who tests positive for the virus and dies would be included in their numbers of coronavirus deaths.

Responding to a question from a reporter about potential underreporting of novel coronavirus deaths in the nation, Dr. Birx responded: “I think in this country, we are taking a very liberal approach to mortality. And I think the reporting here has been pretty straightforward over the last five to six weeks,” she said, adding, “If someone dies with COVID-19, we are counting that.”

Dr. Birx suggested COVID-19 deaths in January and February were likely underreported, due to a lack of testing. “When there wasn’t testing in January and February, that’s a very different situation and unknown,” she explained.

While the U.S.’s death toll has been highlighted in relation to other counties, Dr. Birx pointed out that other nations are not recording as liberally as we are.

“There are other countries, that if you have a pre-existing condition, and let’s say the virus called you to go to the ICU (intensive care unit) and then have a heart or kidney problem,” she explained. “Some countries are recording that as a kidney issue, or a heart issue, and not a COVID-19 death.”

In the U.S., Dr. Birx suggested, “we’re still recording it” as a COVID-19 death.

Guidance from Center for Disease Control and Prevention (CDC) seems to at least somewhat jive with Dr. Birx’s explanation on COVID-19 mortality recording.

“COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death,” reads CDC guidance issued in March. “Certifiers should include as much detail as possible based on their knowledge of the case, medical records, laboratory testing, etc. If the decedent had other chronic conditions such as COPD or asthma that may have also contributed, these conditions can be reported in Part II.”

The New York Times ran a piece Monday outlining the sudden drop in heart attacks and strokes. “I have heard this sentiment from fellow doctors across the United States and in many other countries. We are all asking: Where are all the patients with heart attacks and stroke? They are missing from our hospitals,” said Harlan M. Krumholz, M.D.

“What is striking is that many of the emergencies have disappeared,” the doctor continued. “Heart attack and stroke teams, always poised to rush in and save lives, are mostly idle. This is not just at my hospital. My fellow cardiologists have shared with me that their cardiology consultations have shrunk, except those related to Covid-19. In an informal Twitter poll by @angioplastyorg, an online community of cardiologists, almost half of the respondents reported that they are seeing a 40 percent to 60 percent reduction in admissions for heart attacks; about 20 percent reported more than a 60 percent reduction.”

Dr. Krumholz chalked up the drop to scared Americans, apparently dying in their homes instead of going to a hospital where they might catch COVID-19:

The most concerning possible explanation is that people stay home and suffer rather than risk coming to the hospital and getting infected with coronavirus. This theory suggests that Covid-19 has instilled fear of face-to-face medical care. As a result, many people with urgent health problems may be opting to remain at home rather than call for help.

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