A Very Long Open Letter to Will Jones of The Daily Sceptic Regarding Ventilator and Iatrogenic Deaths in New York City

This is a letter I sent last night to Will Jones of The Daily Sceptic, regarding his article on the extent to which overzealous ventilator use in New York City during the spring of 2020 could have contributed to the city’s mass casualty event. Figures and tables are accessible in a PDF at the end of the letter. I have posted those in a Twitter thread and embedded direct links to each one. I look forward to Mr. Jones’ response, of course, but more than that, I hope people will begin to see how much we don’t know (yet deserve to know) about what occurred.

June 1, 2023

Dear Mr. Jones, 

I am writing this open letter in response to recent article, “Ventilators Were Not to Blame for New York City’s High Covid Death Toll,” in which you concluded that mechanical ventilation can’t be responsible for more than 20% of the Covid deaths in New York City in spring 2020. I believe this estimate is premature, largely because it relies on outdated, incomplete, and muddied data. 

As you doubtless know, hospital deaths in New York were extraordinarily high during the spring of 2020. What you may not know is that more than 30% of hospital in-patient excess mortality in the U.S. during the “first wave” occurred in NYC hospitals alone. The fact that close to one-third of hospital deaths in eleven weeks occurred in a city where less than 3% of Americans live demands consideration of what may have happened beyond the discovery and naming of a novel pathogen. 

Beyond statistics, many real-time media reports, testimonies, and subsequent studies and confessions identify the deadly role ventilators played in a larger iatrogenic, fear-fueled mass casualty event. (A related thread of mine, and articles by Michael Senger and Greg Piper are replete with examples and further context.) Serious questions surrounding those weeks in spring 2020 have not, and will not, go away. For that reason, I appreciate you addressing the ventilator issue head-on from a data standpoint. It is much more than most American journalists have done or are doing. 

My letter is long, but reflects a genuine interest in informing your work and my own independent investigation - as well as the broader inquiries which are sure to come. Hopefully, you will find my response compelling, and we can continue the dialogue as fellow skeptics. 

To challenge your conclusions and draw attention to some of what is known and unknown about NYC’s spring 2020 mass casualty event, I’ll address these key subjects:

1. the scale and timing of the mass casualty event, 

2. where people died (hospital, nursing homes, personal home), regardless of cause, 

3. the number of deaths attributed to Covid, 

4. where people with Covid died, 

5. the number of Covid hospitalizations,

6. the potential number of ventilator deaths,

7. other competing policies & practices that likely contributed to iatrogenic deaths, and

8. what data and information still needs to be released to the public. 

For readability, I’ve put most tables and figures in an appendix. Please let me know if I can provide another format, or if I can supply direct links to the corresponding data. 

In summary, you assert:

• 79% of Covid deaths were in a hospital

• 32% of Covid patients in hospitals died

• 12% of all Covid patients were on ventilators

• 88% of Covid patients on ventilators died

• But 22% of pneumonia patients on vents normally die.

Whereas, I contend:

• The definitions of Covid death and Covid patient distort all of the data.

• 76-83% of Covid deaths occurred in a hospital

• The CFR for patients hospitalized due to Covid is likely 60% or more.

• The percentage of all Covid-positive patients who were ever placed on a ventilator is unknown.

• 88% of mechanically-ventilated Covid patients in one study of Covid-positive patients in the NYC metro area died by the study endpoint.

• The normal rate of ventilated pneumonia patients is represented in the “normal” of hospital deaths; invasive intubation may be overused/ineffective for those patients as well.

The Scale & Timing of New York’s Mass-Casualty Event

We agree that New York City mortality in spring 2020 was high. Your term is “unusually” high. I believe “staggeringly,” “astonishingly,” and “unfathomably” high are more appropriate adjectives. 

You made two, mutually exclusive claims about that can’t both be true: 1) SARS-CoV-2 is “a not-so-deadly virus,” and 2) “there can be little doubt that most of the excess deaths during Covid waves were due to the virus.” These statements leave me wondering if the magnitude of what occurred in New York is clear. 

Roughly 27,000 more people died in NYC between mid-March and the end of May 2020 than in the same weeks in 2019 (Figure 1). You may be surprised, as I was, to learn that the spike in daily mortality rate (per million) exceeded that attributed to the 1918 influenza pandemic (Figure 2). As far as I know, no one has asserted that SARS-CoV-2 is as or more deadly than the Spanish flu. Whatever the role of ventilators or other policy/protocol reactions, it appears that the knowledge gained in 100+ years wasn’t maximized.

Note the timing and steepness of the 2020 New York event. The rise in excess mortality began after the city was shut down, peaking at 1,200 deaths on April 4th. By June, deaths had plummeted back to baseline, where they stayed until December – the month the vaccine debuted, and at a point when NYC was again in the throes of the  respiratory illness season.

You selected the state of Maryland to convey the scale, but Chicago (another large, dense city) is a better comparison for understanding how peerless New York truly is (Figure 3). Despite announcing its first Covid case on January 24th, Chicago’s daily all-cause mortality remained normal until late March. NYC’s, by contrast, began to skyrocket 18 days after disclosing its first positive test.

The mortality rate in both cities jumped after the onset of government “doing something,” with New York’s climbing first, doing so more sharply, and reaching a significantly higher peak mortality rate than Chicago. It’s hard to imagine that the same “spreading” virus (or variants thereof) that topped out at 83 deaths/million in one dense urban center only peaked at 21 deaths per million in another.¹ Non-natural forces and factors must be considered – which is one reason treatment policy differences (including heedless ventilator use) are worth investigation. 

Where New Yorkers Died During the Mass Casualty Event

Your article didn’t address all-cause mortality by place of death (i.e., hospital, home, nursing homes) – only Covid deaths as shown in the CDC’s outbreak report for New York City. Yet it’s important to see what final data show about where New Yorkers died in those weeks, irrespective of cause, to more fully grasp the consequences of sudden policy changes and massive societal disruption on mortality. 

Place of death data for those spring weeks in 2020 are available via the U.S. federal mortality database, CDC WONDER, and can be used to compare with the same weeks in 2019 (Table 1). Most of the increase (62%) occurred in hospital or outpatient settings, which also saw the biggest combined percent mortality increase from 2019, with 285%. 

If 16,661 “extra” deaths isn’t enough to generate interest in what exactly happened in hospitals, the shift toward hospital inpatient and away from other places of death, where they have occurred historically, certainly suggests something highly unusual occurred (Table 2).  The number of patients who died in hospitals in those weeks is difficult to comprehend, given how difficult it would be to handle that number of bodies, even with federal assistance.

The increase is also puzzling alongside reduced hospital patient volumes. Contrary to the impression given to the public, emergency department visits dropped by as much as 60% in this period (Figure 4); ambulance arrivals to hospitals decreased by 29% (Figure 5); and the hospital purported to have been a Covid “epicenter” was not overrun. Other cities like Chicago, Detroit, and New Orleans also experienced high hospital inpatient mortality in those weeks, but none experienced New York’s magnitude (Figure 6).

The increase is also puzzling alongside reduced hospital patient volumes. Contrary to the impression given to the public, emergency department visits dropped by as much as 60% in this period; ambulance arrivals to hospitals decreased by 29%; and the hospital purported to have been a Covid “epicenter” was not overrun.

More could be said about the increases and decreases in non-hospital places of death. For now, I’ll note that the ~5,300 additional deaths occurring at home (Table 1) are corroborated by a 285% increase in patients pronounced dead at the point of ambulance dispatch pickup (Figure 7). Most of this increase was heart-related deaths - an inevitable consequence of telling people to stay away from hospitals for anything that wasn’t potentially a severe symptom of Covid.

Deaths in the Mass Casualty Event that Were Blamed on Covid

The “official” number of Covid deaths that New York sustained during the mass casualty event has been difficult to discern, because different sources showed different numbers. Your analysis uses 23,195 – the number of confirmed and probable Covid deaths reported through June 1, 2020, in CDC’s New York City “outbreak” report. 

Living outside the U.S., you may or may not remember the fanfare around the addition of these deaths. As the CDC outbreak report notes, the New York City Department of Health and Mental Hygiene (NYC DOHMH) began adding “probables” on April 14th, defining them as “no known positive SARS-CoV-2 test result and death certificate listing cause of death as COVID-19 or an equivalent term [e.g., COVID, SARS-CoV-2, or another term.” It was a widely-reported decision with considerable real-time impact. Not only did it instantly increase the reported U.S. toll by 17%, it also fueled the narrative of a city (and country) besieged by a deadly virus. In total, probable Covid deaths make up nearly one-fifth (n=4,516) of the 23,195 number on which your analysis relies. 

Not only did New York City’s addition of “probable” Covid deaths instantly increase the reported U.S. toll by 17%, it also fueled the narrative of a city (and country) besieged by a deadly virus.

The table you created is very helpful for showing where NYC DOHMH said these probable Covid deaths occurred: 44% in hospitals, 30% at home, and 26% in nursing homes. I’ll return to the matter of where Covid deaths occured in the next section of this letter.

You should be aware that these probable Covid deaths do not appear to have made the “final cut” in New York City’s 2020 vital statistics report, which was finally published in April of this year. The report mentions the probable deaths, and explains how NYC DOHMH was counting Covid deaths as and after the spring mortality wave was occurring. (Pictured below; data is for the entire 2020 calendar year.)

For NYC DOHMH, the basic distinction between confirmed and probable deaths was a positive PCR test, with confirmed Covid deaths occurring as many as 60 days after the test result. 

Their “Important Notes” go on to say that all Covid-related mortality statistics in the report itself are Covid deaths as defined by the WHO, i.e., confirmation of “Covid-19” by laboratory testing “irrespective of severity of clinical signs or symptoms.” This criterion is highly problematic on its own accord, but applying it appears to have excluded many of the probable deaths from analysis in the report.

For the spring period only, the sum of raw data I obtained via FOI request² shows 19,253 Covid deaths and 20,465 “non-Covid” deaths for 3/1/2020 through 5/31/2020 (Figure 8).  Finalized data also show 28% of the total mortality increase was non-Covid deaths. As of today, DOHMH has not responded to my question about how many deaths once-labeled “probable” Covid deaths are among the 19,253. Though I believe deaths attributed to Covid are grossly exaggerated, taking the number at face value still gives a different number that is lower than the 23,195 you used in your analysis. 

Where Deaths Blamed on Covid Occurred During the Mass Casualty Event

Returning to the question of where New Yorkers died during this event, the city’s vital statistics report doesn’t show the places of death for Covid deaths during the spring weeks – only for the year. But CDC WONDER shows where deaths that attribute Covid as underlying cause occurred in weeks 12-22 specifically (Table 3)³. Because you used the CDC outbreak report, and included the probable deaths, your percentages differ a bit from mine.

The highest proportion of Covid deaths by far occurred in hospital inpatient/ emergency departments, and outpatient settings (83%). The equivalent of nearly all of the hospital inpatient increase from 2019 is blamed on Covid (14,704 of 14,990). The implication of this is that other disruptions and policy changes had little to no effect on the number of deaths occurring in hospitals - which I’m sure you can agree defies credulity.

You might counter that most Covid deaths occurring in hospitals makes sense in an “outbreak” event, because people who were sick with the newly-detected, newly-named pathogen went to the hospital, while everyone else stayed away. Even if that were true, it’s hard to ignore that U.S. hospitals were incentivized to code visits,  inpatient admissions, and deaths with U07.1, on account of being compensated with federal funds for doing so. 

Though including probable Covid deaths gave you a higher nursing home percentage, (12%), I agree with you that there’s a limit to how many of those deaths can be blamed on the Cuomo administration’s so-called nursing home order.⁴ Only 9% of all Covid deaths were in nursing homes; moreover, most of the increase in nursing home deaths (63% = 3,083/4,880) is not blamed on the virus.⁵ As shown previously in Table 2, the proportion of deaths occurring in nursing facilities didn’t change much (+1.59%), especially as compared with hospitals (+8.55%).

Similar to nursing homes, at-home Covid deaths (n= 1,426) were dwarfed by at-home deaths from other underlying causes above the 2019 “norm” (n=3,880). I have long questioned the general concept of an “at-home Covid death” that wasn’t someone discharged from a hospital or nursing home where they tested positive. Though tests for SARS-CoV-2 were perceived to be restricted outside of healthcare settings, it’s reasonable to wonder whether the NYC medical examiner was swabbing the deceased – like the Cook County, Illinois, medical examiner was doing, under order.

Suffice to say, where people died in New York’s mass casualty event says much about how people could and could not have died, which I believe you tried to account for in your approach to estimating how many Covid deaths could possibly be due to ventilator mis-use.

Covid Hospitalizations 

Three percentages in your estimate use “Covid patient” or Covid hospitalization. Though this makes sense in a ventilator death estimate, the definition connected to Covid patient is one that is linked to a PCR test result, rather than to the presence of certain symptoms or the reason for hospital admission. 

To wit, the JAMA study from which you extrapolate ratios  - “Presenting Characteristics, Comorbidities, and Outcomes Among 5,700 Patients” - used Northwell Hospital System⁶ data from patients who were “hospitalized with Covid-19 in the New York City area” between March 1 and April 4, 2020. Note how the study authors describe the subjects [emphasis mine]:

“All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample.”

They also say, 

“Patients were considered to have confirmed infection if the initial test result was positive or if it was negative but repeat testing was positive. Repeat tests were performed on inpatients during hospitalization shortly after initial test results were available if there was a high clinical pretest probability of COVID-19 or if the initial negative test result had been judged likely to be a false-negative due to poor sample collection.” 

At triage, 31% of the patients had a fever, 17% a respiratory rate greater than 24 breaths/min, and 28% received supplemental oxygen.

In other words, these were people who came to the hospital with indications of various kinds, were deemed suitable to admit, and who tested positive for SARS-CoV-2 before or shortly after admission. No symptomatic criteria were applied, and no patients hospitalized for another reason are excluded. 

I can’t speak to definitions in the U.K., but U.S. federal and state/local agencies eventually acknowledged that a “Covid hospitalization” didn’t distinguish between patients with incidental positives and patients hospitalized with or for respiratory symptoms and treatment for Covid. During the January 2022 “Omicron wave,” New York Governor Kathy Hochul announced the state would begin disaggregating daily Covid hospitalizations into “admissions due to Covid” and “admissions not due to Covid.” 

Unsurprisingly,  the data show close to 50% of admissions that month were not due to Covid (Figure 9). The same data from before January 4, 2022 are absent from the data file, which raises questions about what the state is hiding, and why.

There’s no reason to believe that a similar proportion doesn’t apply to spring 2020. Even if the percentage of “for Covid” was higher, the CDC’s “Covid hospitalizations,” number for New York City between 2/29/20 - 6/1/20 (n= 54,211) is inflated. At the very least, using that number for calculating hospital case fatality rate (CFR) or for estimating ventilator deaths results in lower percentages than using a denominator that excludes patients who were hospitalized without Covid-related symptoms, or for non-Covid reasons. 

In the absence of “from/with” hospitalization data for the spring 2020 period, a “for Covid/suspected Covid” hospitalization proxy can be derived from the number of daily Covid-Like Illness (CLI) hospital admissions. The city health department defines CLI admissions as admissions via the emergency room with admission codes that include influenza-like illness (ILI), pneumonia, or a Covid diagnosis (U07.1). The data source also gives a baseline for each day (Figure 10). The sum of baseline ILI and pneumonia admissions minus the sum of CLI admissions in the spring 2020 period is 24,335 patients (Table 4).

If this is a reasonable approximation for hospitalizations “due to” diagnosed or suspected Covid, it suggests a CFR of 61% among inpatients (=14,990/24,335). That’s more than double the rate in the CDC study, which reported that 32.1% of hospitalized Covid patients “were known to have died”.⁷ 

Alternatively, if we accept a 50% reduction, consistent with what the disaggregated data published in 2022 show, this gives 27,105 admissions due to Covid, which is in the same general vicinity as the CLI approach.

Either way, we’re left with a denominator that is lower than ~54,000, a CFR higher than 31%, and a challenge to your extrapolation asserting that 12% of hospitalized Covid patients or so were ever on a ventilator.

Admittedly, my proxies don’t account for nosocomial infections that may have resulted in illness or death attributable to Covid, but it’s unlikely such infections comprise a substantial portion of the gap between ~54,000 and ~24,000. 

No matter what, the difference raises questions about whether mass-testing in hospitals and an overbroad definition of “Covid hospitalization” create the appearance of sudden spread of a new deadly disease, whilst compensating hospitals for low patient volumes. 

Covid Ventilator Deaths

Because your article was brief and to the point (unlike my letter), I’m not sure if you’re aware of the sheer force of the ventilator push in the U.S. - and in New York in particular - in March and April 2020. 

Early on, ventilators were promoted not chiefly for saving the life of a “Covid patient,” as much as for sparing hospital staff from breathing and getting sick or dying from virus particles.  “First, protect thyself,” was the ethically-questionable message from agencies, professional organizations, and medical consulting groups alike. 

Meanwhile, the political clamor over ventilator supply quickly turned into a battle between blue-state governors and President Trump. New York Governor Andrew Cuomo was the loudest state executive pushing ventilators as a necessary “weapon” in the “war” against Covid-19, and likened them to missiles used in World War II. 

This choice of metaphor begs two questions, at least: 1) Once acquired, were the “missiles” used discriminately, or indiscriminately? and 2) How many “friendly fire” deaths resulted from the use/misuse of these “missiles”? 

Cuomo’s choice of metaphor begs two questions, at least: 1) Once acquired, were the “missiles” used discriminately, or indiscriminately? and 2) How many “friendly fire” deaths resulted from the use/misuse of these “missiles”? 

I think you’re correct to subtract the number of people who “normally” die on or as a direct/indirect result of having been on a ventilator from an estimate of how many New Yorkers could have died from over-zealous intubation. But I believe those deaths are represented in the 2019 place of death number for hospital inpatient mortality. 

You also seem more willing than I am to accept that SARS-CoV-2 was novel in early 2020, increased risk of death (via pneumonia, etc.), and therefore necessitated high use of ventilators. I find it difficult to divorce the advent of naming and testing for a “new” pathogen from decisions to treat it differently from pneumonia caused by other agents. 

It’s also worth considering that intubation may not be a proven life-saving practice. The New York Times reported on practice in 2018. Two years later, as New York’s hospital mortality was declining, Off-Guardian asked pointedly, “Are ventilators killing people?”, citing a number of doctors from the U.S. and other countries who spoke to the potential harms of ventilator use. One from Northwell Health System, Dr. Paul Mayo, is quoted: “Putting a person on a ventilator creates a disease known as being on a ventilator.” At minimum, it must be recognized that ventilators are not “a [medical] truth universally acknowledged”⁸ when it comes to effective treatments for patients with pneumonia, etc.

“Putting a person on a ventilator creates a disease known as being on a ventilator.” - attributed to Dr. Paul Mayo

While it’s possible that some of the deaths that occurred in nursing homes and personal homes were patients who died as a result of treatment they received in the hospital (e.g., from ventilator-induced lung injury), on the whole, I agree with you that most “unnecessary” deaths from ventilator use would be among the number of Covid-attributed deaths in hospitals. 

It’s also difficult to ignore that U.S. hospitals received more money for visits, admissions, stays, and deaths that included U07.1 - and money on top of that if a patient was on a ventilator. So, yes, most deaths resulting in whole or part from being intubated for “treatment” of diagnosed or suspected Covid would have occurred among hospital inpatient Covid deaths. However well-intended the financial incentives may have been, in practice, they fueled a vicious cycle that it became hard for hospitals to escape.

Your source for the 88% fatality rate among Covid patients on mechanical ventilators comes from the Northwell study I referenced previously. When the study was published on April 22, 2020, the ventilator outcome was reported widely in mainstream media. Even former FDA Commissioner and Pfizer board member Scott Gottlieb took note. You likely noticed that the study endpoint left outcomes for over 3,000 patients unreported. To my knowledge, the researchers did not publish an update regarding outcomes for those patients. Nevertheless, the “preliminary” finding among discharges who had been on a ventilator casts serious doubt on the efficacy of ventilators as a necessary or life-saving measure.

A recent study from researchers at Northwestern University’s Feinberg School of Medicine – published shortly before your analysis – suggests that some Covid patients placed on ventilators died not from the “novel” disease but from secondary bacterial infections associated with ventilator use. Surely if this was the case for patients in one Chicago hospital, it was the case in New York hospitals as well.

Even Anthony Fauci recently admitted that mechanical ventilation was overused:

“We very, very readily would put people on mechanical ventilation. When we found out through clinical experience it might have been better just to make sure we position them properly in the prone or supine position, and not necessarily intubate somebody so readily, which might have actually caused more harm than good.”

This confession should generate public outcry for the U.S. Department of Health and Human Services (HHS) and the CDC to report outcomes for patients who tested positive for Covid and were intubated.

Specific to New York City, we need to know, “How many of the 14,704 Covid deaths that occurred among hospital inpatients were patients placed on a ventilator during their stay?”

Unfortunately, those descriptive data don’t yet exist – which is why you had to approach the questions with a lengthy procedure for arriving at a 20% estimate. No entity has reported the daily number of newly-intubated patients in NYC hospitals, or the number of patients who died (from Covid or other causes) that were intubated at some point during these weeks. Skeptical journalists like yourself must wonder why.

ICU census data for NYC hospitals are available via the New York state health department and paint a startling picture (Figure 11). Not only were 80%-90% of all ICU patients Covid-positive for multiple weeks, but 85-93% of Covid+ patients in the ICU were intubated (Figure 12). 

The dataset starts March 26, 2020, making it impossible to see changes from the beginning of the month, or compare to flu season peaks (Figure 13). What we can see is the ICU census for intubated Covid-positive patients rose 183% between March 26th and April 14th, from 956 to 2,713, and didn’t drop below 1,000 again until May 15th. 

So, at minimum, there were 2,713 Covid-positive patients ICU-intubated. Applying the 88% mortality rate from the Northwell study to the peak intubation census gives 2,387 deaths. That’s 12% of all Covid deaths, and 15% of Covid deaths that occurred in hospital in-patient, which is consistent with your conclusion that no more than one-fifth of Covid-blamed deaths in New York City hospitals could possibly be related to ardent ventilator use. 

However, there’s no way to know how many individual patients were placed on and taken off ventilators each day. If, for example, the total number of intubated Covid-positive patients was 5,000, an 88% fatality rate sends the estimate over 20%. 

The same data source for Covid patients intubated in the ICU also provides the number of Covid deaths that hospitals reported daily, which shows 13,942 reported from March 26 through May 31 (Figure 14). Almost half of these deaths (n=6,521) were reported in the first 15 days of April. This was in addition to non-Covid deaths that were occurring. I don’t know if the idiom “hot mess” is used on your side of the pond, but it characterizes the current data situation with respect to New York’s mass casualty event quite well, from my point of view.

With respect to the numbers, the table below provides a more detailed summary of the mathematical assertions you used to derive your estimate that ventilators could be no more than 20% of Covid-blamed deaths in New York City, alongside my responses:

Really, neither you nor I should have to deduce how many hospital deaths blamed on Covid were patients who were “treated” with mechanical ventilators. The records exist, and the data should be released to the public. 

Beyond Ventilators

Ultimately, a forced dilemma like “Virus or Ventilators?” short-changes the myriad causes of and complexities involved in New York City’s spring 2020 mass casualty event. Even the most conservative estimate leaves New York with a very high number of Covid-blamed deaths that need to be explained. 

Ventilator fervor wasn’t the only sudden change in March that increased mortality risk for patients. Other measures and responses included, but are not limited to,

• increased testing for one pathogen (SARS-CoV-2) and reduced testing for others,

• encouragement to use experimental drugs such as Remdesivir.

• questionable baselines for gauging hypoxia,

• barring visitors/3rd-party witnesses, 

• widespread use of isolation procedures,

• absolving staff of closely maintaining patient records, and 

• ethical permission for withholding CPR and issuing unilateral Do-Not-Resuscitate (DNR) orders.

In essence, a disaster-medicine mindset and environment was activated over fears about what could occur. This gives many reasons to suspect that iatrogenic deaths include not only those that list U07.1 (the classification code for Covid-19) as underlying cause, but many others as well. 

The question isn’t “How many New Yorkers did ventilators kill?” It’s “Who were the thousands of ‘extra’ people that died in New York hospitals? Why did they come to the hospital, and what happened to them when they were admitted?” 

The question isn’t “How many New Yorkers did ventilators kill?” It’s “Who were the thousands of ‘extra’ people that died in NYC hospitals? Why did they come to the hospital, & what happened to them when they were admitted?” 

Certainly, the causes of deaths in congregate settings (Covid-blamed and otherwise) also have iatrogenic factors of their own, including non-treatment and neglect. Iatrogenic may be the wrong word for the 183% increase in deaths at apartments/houses during these weeks. Yet most, especially heart attack and stroke deaths, were preventable and actionable in real-time, if officials had reversed course on their “stay home, save lives” messaging.

The causes of New York City’s mass-casualty event in spring 2020 are knowable. For starters, officials must be compelled to release de-identified death certificates for all New Yorkers who died in those months, if not from 2018 through 2022. Data from patients charts and billing codes should be aggregated and disclosed. Better yet, an independent non-partisan federal inquiry should be ordered to determine exactly what happened and why it has taken so long for the truth to be uncovered. More journalists need to engage with the data, as you have done, and ask tough but simple questions that should have been asked and answered long ago. “How many Covid deaths were ever on a ventilator?” and “Can New York City provide the de-identified death certificates for every death that occurred in 2020?” are among the most obvious.

Until then, all inpatient, outpatient, and emergency department deaths in those weeks should be considered potentially iatrogenic in one way or another.

Thank you again for your interest in this topic 

Warmest regards,

Jessica Hockett, PhD

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1. Chicago has published basic de-identified death certificate data that helps verify the deaths occurred; New York City has not done the same, but should do so as soon as possible, in the interest of transparency.

2. That is, the raw data underlying the figure C1 on page 55 of the 2020 Vital Statistics report.

3. There is a slight discrepancy between the city’s number of Covid deaths in the period and the CDC’s number that is negligible for purposes of this analysis.

4. The advisory, which was issued on 3/25/2020 and was consistent with federal guidance at the time, told nursing home & long-term care facilities they couldn’t reject a new or returning resident on the basis of the person’s Covid status alone. The impetus for the policy at the time was freeing up hospital beds, in preparation for  an anticipated patient surge. Reportedly, the Greater New York Hospital Association played a role in pressuring Cuomo to issue the directive.

5.  Data released by the state health department in 2022 reports Covid-related nursing home resident deaths that occurred at hospitals (not all-cause). Current figures show ~2,000 in the period of interest, which is less than 10% of the hospital/outpatient all-cause total. The state has not released the number of nursing home residents who died in the spring 2020 wave, regardless of cause or place.

6. FYI, some hospitals in the study are in the metro area, not in New York City proper, which matters for applying the numbers in the study to provisional death numbers in the CDC’s outbreak report for New York City.

7.  Presumably, this means “died at the hospital,” but the language doesn’t specify.

8.  h/t Austen, J. (1813). Pride and Prejudice, p. 1.