Starting January, 2022, Rhode Island hospitals were asked to categorize COVID-19 patients into one of the following three main hospitalization groups at time of discharge, and the results were tabulated weekly by the Rhode Department of Health (RIDOH):
Primary Cause: Defined as a patient with respiratory or other symptoms that are the cause of the patient’s hospital admission, attributed to either known or suspected COVID-19. Examples include a patient admitted with respiratory distress in the setting of a known COVID-19 positive test.
Contributing Cause: Defined as a patient who is admitted to the hospital for a reason that is directly related to COVID-19. Examples include a patient who is admitted with “dizziness” and found to be dehydrated due to COVID-19, or a patient who fell and had a fracture, and the fall was due to dehydration and COVID-19.
Not a Cause: Defined as a patient who is admitted to the hospital with a positive COVID-19 test, but COVID-19 does not contribute to the cause of the hospitalization.
Both the “Primary Cause” and “Not a Cause” designations for hospitalization are straightforward and appropriate. However, “Contributing Cause” is far too elastic, distorting (by inflating) the direct clinical burden of covid-19, which is caused by an eponymous respiratory coronavirus, Severe Acute Respiratory Syndrome-2 (SARS-CoV-2). The overwhelming manifestation of SARS-CoV-2 is discrete respiratory illness, as confirmed by multiple autopsy studies (see here; here; here), the latter study concluding,
“…our detailed analyses suggest that the SARS-CoV-2 spreading beyond the respiratory tract does not induce any major pathology and might be rather negligible in comparison to the pulmonary involvement… Apart from the respiratory tract, no specific (histo-)morphologic alterations could be assigned to the SARS-CoV-2 infection.”
RIDOH’s covid-19 “Contributing Cause” examples highlight that designation’s overly broad, clinically irrelevant absurdity. International Classification of Diseases (ICD) codes already exist for the myriad etiologies of dehydration (E86.0) or dizziness (R42) as stand alone, primary discharge diagnoses. Singling out covid-19 as a “Contributing Cause”, exclusive of all other etiologies of “dehydration,” or “dizziness,” selectively distorts—i.e., increases—hospitalization counts for covid-19, alone.
At present, RIDOH provides a weekly update (dating back to January 22, 2022) of “Primary Cause,” “Contributing Cause,” and “Not a Cause” hospitalizations for all ages, in aggregate. On Wednesday, May 25, 2022, I sent the email, just below, to RIDOH spokesperson Joseph Wendelken, requesting the same public data displayed weekly, only broken down into age strata, either granularly, or for RIDOH’s convenience, just separating those 0 to 17 years old, from those 18+ years of age.
From: Andy <abostom@cox.net>
Sent: Wednesday, May 25, 2022 3:04 PM
To: Wendelken, Joseph (RIDOH) <Joseph.Wendelken@health.ri.gov>
Subject: [EXTERNAL] : Age stratification of these data possible ?
Dear Joseph,
According to the RIDOH dashboard, https://ri-department-of-health-covid-19-data-rihealth.hub.arcgis.com/ 33.6% of current covid-19 hospitalizations are “primary” hospitalizations.Can you or someone else within RIDOH age stratify these data please, i.e., % primary hospitalizations by age category?
The age strata here https://ridoh-covid-19-response-hospital-data-rihealth.hub.arcgis.com/ [ridoh-covid-19-response-hospital-data-rihealth.hub.arcgis.com] are 0-4; 5-9; 10-14; 15-18; 19-24; 25-29; 30-39; 40-49; 50-59; 60-69; 70-79; 80-89; 90+If these are too granular, could it at least be broken down by 0-18; and then 18+? Andy Bostom, MD, MS
Mr. Wendelken replied on Friday, May 27, 2022:
From: Wendelken, Joseph (RIDOH) <Joseph.Wendelken@health.ri.gov>
Sent: Friday, May 27, 2022 12:05 PM
To: Andy <abostom@cox.net>
Subject: RE: [EXTERNAL] : Age stratification of these data possible ?
Hello Dr. Bostom,
Sorry for the delay. I will look into this. My colleague Annemarie [Beardsworth] may get back to you, as I will be out next week.
Joseph Wendelken | Public Information Officer
Rhode Island Department of Health
3 Capitol Hill, Room 401; Providence, Rhode Island 02908
joseph.wendelken@health.ri.gov
Desk: 401-222-3998 | Mobile: 401-378-0704
Sixteen days after my 5/25/22 request, on 6/10/22, I received RIDOH’s response via Annemarie Beardsworth. Despite several intervening exchanges with Ms. Beardsworth, RIDOH refused to reveal the “Primary Cause” hospitalization data, independently, stubbornly insisting upon pooling it with “Contributing Cause” hospitalizations. Here are the most relevant email exchanges:
From: Andy <abostom@cox.net>
Sent: Monday, June 6, 2022 1:41 PM
To: ‘Beardsworth, Annemarie (RIDOH)’ <A.Beardsworth@health.ri.gov>
Subject: Please have the following Table filled in with data requested. Thanks!
Please have the following Table filled in with data requested. Thanks!
From: “Beardsworth, Annemarie (RIDOH)” <A.Beardsworth@health.ri.gov>
Date: 6/10/22 3:21 PM (GMT-05:00)
To: Andy <abostom@cox.net>
Subject: RE: [EXTERNAL] : Will I be getting these simple data today? It has been 2-weeks now since they were requested
Here is the data you requested:
Total and Primary/Contributing COVID-19 Hospitalizations
[During Most Recent 16-Week Period, RIDOH, 2/13/22 – 6/4/22]
Among Those 0-17 Year-Olds and 18+ Year-Olds
Annemarie Beardsworth, CCPH
Provider and Internal Communications, Rhode Island Department of Health
COVID-19 Joint Information Center, State of Rhode Island
401-222-5086 | a.beardsworth@health.ri.gov
Ultimately, I brought RIDOH’s recalcitrance to the attention of my RI State Senator Jessica Delacruz, whom I copied on my last email appeal to Ms. Beardsworth (email below). As of this essay’s completion (on 6/16/22), notwithstanding Sen. Delacruz’s own additional requests for the “Primary Cause” hospitalization data, RIDOH has refused to divulge it.
——– Original message ——–
From: “Beardsworth, Annemarie (RIDOH)” <A.Beardsworth@health.ri.gov>
Date: 6/10/22 4:07 PM (GMT-05:00)
To: abostom <abostom@cox.net>
Subject: RE: [EXTERNAL] : Will I be getting these simple data today? It has been 2-weeks now since they were requested.
I checked with the Data Team and they shared that they had to aggregate both “primary” and “contributing” categories due to small numbers in the 0-17 age category. Together, these two categories are usually combined to describe those hospitalized “due to” COVID. We only began looking at due to/with COVID breakdowns in February 2022, so there is no additional data prior to February for the Team to aggregate.
Annemarie Beardsworth, CCPH
Provider and Internal Communications, Rhode Island Department of Health
COVID-19 Joint Information Center, State of Rhode Island
401-222-5086 | a.beardsworth@health.ri.gov
From: abostom <abostom@cox.net>
Sent: Friday, June 10, 2022 4:44 PM
To: Beardsworth, Annemarie (RIDOH) <A.Beardsworth@health.ri.gov>; abostom@cox.net
Cc: jessicaforri@gmail.com
Subject: I don’t understand the response; The public dashboard separates primary from contributing
Importance: High
Annemarie,
I don’t understand the response. The public dashboard separates primary from contributing very distinctly. Also I asked for specific numbers no matter how large, or small. It is reasonable to say small numbers over this period certainly are not representative of the entire pandemic, or even the entire omicron period. But they are concrete numbers, regardless. And that is what I want: the simple, concrete numbers of primary C19 hospitalizations for the specific period RIDOH itself has defined, which covers almost 4 full months. I don’t know why this is problematic, and find the obstinacy over the matter very troubling. Please send me the data on primary hospitalizations I requested without any further bickering. I am now copying my State Senator Jessica Delacruz on this matter so it gets resolved appropriately.
Andrew Bostom, MD, MS
Why have I been so adamant to obtain these data?
First, there is RIDOH’s basic obligation, as a public, taxpayer funded entity, to respond to such a reasonable, easily fulfilled data request, promptly and completely. Moreover, consistent with RIDOH’s own pronouncement in early March, 2022, candid, accessible metrics of covid-19 hospitalizations are integral to “transitioning” RI’s covid-19 response “from pandemic to endemic.” Dr. Philip Chan, a RIDOH infectious diseases specialist, and consulting medical director, described in a March 4, 2022 Providence Journal story how these updated metrics riveted upon covid-19 hospitalizations, as opposed to mere “infections,” including
“…new COVID-19 admissions per 100,000 population in the past 7 days, [and] the percent of staffed inpatient beds occupied by COVID-19 patients.”
Immediate examples of how these ostensibly “hospital-based” metrics affected covid-19 policy for RI children were the snapback late May, 2022 reimpositions of school mask mandates in both Central Falls and Providence, after only brief hiatuses. Following parental protest, including legal action, the reinstituted Providence school mask mandate was abruptly suspended, within days. It was claimed the sudden, renewed suspension of masking in Providence schools was due to changed “metrics,” but the only data referenced were covid-19 infections, not hospitalizations, let alone pediatric covid-19 hospitalizations, specifically.
“The district said the average daily cases decreased from 60 last week to around 45 this week.”
RIDOH memos dated 5/19/22 and 5/20/22, which are believed to have exerted considerable influence on the decisions by both Central Falls and Providence to re-implement their school mask mandates, also avoided any mention of pediatric covid-19 hospitalizations in their “rationales.” The 5/19/22 memo advocating school mask mandates, for example, refers to “increases in [covid-19] cases,” and case “clusters” among children, but is silent on the matter of hospitalization increases as a justification.
Rhode Island has seen increases in these areas in the last several weeks, including increases in cases among school-age children. Many clusters of cases have been associated with extracurricular events, such as theater or drama programs and field trips.
Concerns about the basic validity of “total” pediatric covid-19 hospitalization data transcend this unnecessary local imbroglio with RIDOH. Two companion reports published in Hospital Pediatrics during May, 2021 (from central and northern California centers), upon chart review, indicated some 40-45% of “SARS-CoV-2 positive” hospitalizations were unrelated to clinical covid-19, and the positive tests were purely incidental to their admissions. [see: Kushner LE, et al. “For COVID” or “With COVID”: Classification of SARS-CoV-2 Hospitalizations in Children. Hosp Pediatr. 2021; Webb NE and Osburn TS. Characteristics of Hospitalized Children Positive for SARS-CoV-2: Experience of a Large Center. Hosp Pediatr. 2021.] These data were compiled during a period where more virulent strains of SARS-CoV-2 were predominant, relative to the milder presently circulating omicron, and omicron subvariant strains.
Furthermore, as virtually all true covid-19 deaths, particularly the rare tragic deaths among children, occur within hospital settings, inappropriately designated pediatric “covid-19 hospitalizations,” beget factitious pediatric “covid-19 deaths.” This was demonstrated in a country-wide U.K. analysis which reported 56.2% (102/185) of ostensible “covid-19 deaths,” were in fact unrelated to covid-19, upon medical record review (including autopsy data, when available).
Consistent with these findings, but on a much smaller scale, cross-examination during Superior Court testimony here in Rhode Island established that the initial claim by RIDOH’s current Acting Director, Dr. James McDonald (p.33) that three Rhode Island children died “as a result of covid-19,” was untrue. There have been zero Rhode Island pediatric deaths, throughout the course of the pandemic, where covid-19 was the unambiguous primary cause.
RIDOH’s stonewalling on the release of the primary pediatric hospitalization data it possesses must be viewed in this larger context of misrepresentations, each overstating the severity of pediatric covid-19, an overwhelmingly benign disease in children. Simply put, RIDOH has engaged in a disingenuous ginning up of unwarranted fears over childhood covid-19, conjoined to its aggressive promotion of futile, and even damaging restrictions on this very low covid-19 risk population.
It is well past due for thorough public interrogation of RIDOH’s entrenched upper echelon bureaucrats whose “management” of covid-19, especially in children, has been tantamount to public health Lysenkoism. Legal discovery with depositions of RIDOH officials soon shared with all Rhode Islanders, further open court legal hearings, as well as public investigative state legislature hearings, should proceed immediately.
