The Most Persistent Myth About COVID-19
Six years on and people are still making this ridiculous claim.
It’s been a remarkable 6 years since the start of the COVID-19 pandemic. Throughout that time, we’ve seen viral misinformation spread across the globe, moving at a pace so rapid that it’s hard to even know where the myths started in the first place. There’s been the consistent promotion of ineffective medications such as ivermectin, the idea that the COVID-19 mortality rate was lower than that of influenza, and a whole swathe of arguments about “lockdowns” that rarely even attempt to define what a lockdown is.
There’s one myth in particular that has been astonishingly robust over the last half decade—the idea that COVID-19 only kills people who are already unwell. This persistent argument suggests that no one really died due to COVID-19, because they were all already very sick to begin with, usually from chronic diseases. It’s not that we had a pandemic, it was the existing issues with diabetes, heart disease, and similar that made the death toll so high.
You can hear this exact argument from RFK Jr. as recently as this April. Here’s the full quote from 1:41:56:
“during COVID, we had the highest death rate of any country in the world. And when you ask CDC, why is that true? They say, well, it's because we're the sickest population. The average American who died from COVID had 3.8 chronic diseases. What was killing them? COVID or the chronic disease? You have to understand infectious disease has a very hard time killing healthy person.” - RFK Jr. April 17th 2026
It’s a remarkable statement. Imagine if we could’ve gotten rid of the pandemic by eliminating chronic diseases! That would be a truly wonderful world.
It’s also total nonsense. The idea has been going around since mid-2020, but it’s never been even a tiny bit accurate. While chronic diseases do certainly increase your risk of death from COVID-19—or anything, really—and many people who died in the pandemic were older and may have had chronic diseases, both the numbers that RFK Jr are citing and the underlying concept are entirely wrong.
Comorbidities
The first thing that we can easily fact-check is that 3.8 number. Where does it come from?
This is something I last wrote about in 2020. The underlying facts have not changed. If you look at the CDC website relating to COVID-19 deaths, it discusses “Comorbidites and other conditions”. The CDC notes that:
“For over 5% of these deaths, COVID-19 was the only cause mentioned on the death certificate. For deaths with conditions or causes in addition to COVID-19, on average, there were 4.0 additional conditions or causes per death.”
This isn’t quite the 3.8 number that RFK Jr. cites, but looking at archived versions of the site I could see quite a bit of variance around that number. The exact figure of 3.8 comorbidities appears to have been sourced from the website in early 2021, as you can see using the Wayback machine. It also appears in RFK Jr.’s book about the pandemic, which he was writing at around that time.
The problem with this 3.8/4 number is that it is not chronic diseases. You can tell this immediately if you look at the table on the CDC website:
The issue is pretty obvious. For example, the second most common condition that occurred in someone who died of COVID-19 was “respiratory failure”. This is not a comorbidity or a chronic disease in the traditional sense, it’s something that COVID-19 directly causes. Calling it a comorbidity is a bit like calling bleeding a comorbidity for someone who was just stabbed.
This all has to do with how we record deaths. The US uses standardized death certificates like this one. Most countries are very similar. These have entries for the immediate cause of death—the thing that finally killed a person—as well as underlying causes of death. So, for example, if someone has a car accident, needs major surgery, and finally dies a week later from a secondary infection in ICU, the infection would be the immediate cause of death, surgical complications would be the secondary underlying cause, and the accident would be the underlying cause.
In addition, there’s a space for “other significant conditions contributing to death”. This is usually where you’d put comorbidities such as diabetes or chronic respiratory issues. But in their reporting, the CDC did not distinguish between a condition contributing to death and a secondary underlying cause—they just reported all of the conditions that were listed as either contributing or causing death.
If you take another look at the table, you can see how ridiculous RFK Jr’s argument is. There were a total of 1,146,242 deaths from COVID-19 when this website was archived. Of these deaths, just under 15% had diabetes listed as a contributing issue. That’s only slightly higher than the US national diabetes prevalence, which is estimated at 12% (or around 15% of adults).
We also know that most of the deaths attributed to COVID-19 were caused by the virus. The CDC has run careful audits to confirm that COVID-19 was the underlying cause of death on individual death certificates rather than some other issue. You can see this in the death statistics, which are still available on the CDC website: in 2021, for example, at least 90% of COVID-19 deaths were directly caused by COVID-19*.
There are also other sources of information that confirm this fact. Excess mortality, for example, shows an increase during COVID-19 waves that is not attributable to other causes of death. The authors of this recent paper demonstrated this by showing that neither non-pharmaceutical interventions (“lockdowns”), war or natural disasters, or other causes of death explained the increased mortality during the pandemic. The deaths were solely caused by infections of the virus itself.
The Neverending Story
I don’t expect this myth to die. It’s not as if RFK Jr. is going to check his facts on any major issue any time soon, and the many people who’ve lied about the pandemic for years aren’t changing their tune either. No one has any great interest in reconsidering their deeply held beliefs about COVID-19, even when those beliefs are built on total nonsense.
But it’s still important to push back on these falsehoods. Yes, some people who died of COVID-19 had comorbidities. But we know, due to the hard work of many scientists, that the comorbidites are not what killed them. The virus is.
Being “healthy” is great, but it doesn’t protect you from all disease. The biggest factor for chronic diseases is age, and it’s hard to escape the clutches of time. It’s true that the US might’ve had a slightly lower death toll from COVID-19 if the obesity rate was a bit lower, but the impact would’ve been extremely small. Probably in the range of thousands of deaths, perhaps even fewer than that.
On the other hand, if there was no COVID-19, there would be at least 1,146,242 fewer deaths between 2020 and 2023.
*Note: interestingly, you can also see that this number goes down dramatically over time. It’s been 66/67% since 2024. That’s actually what we’d expect, because the virus has become dramatically less dangerous. So not only are there fewer COVID-19 deaths than in 2021, there are fewer deaths where COVID-19 was the chief underlying cause. These days, at least 1/3 of COVID-19 deaths are actually caused by something else, which was not the case at all in 2020 and 2021.
Based on death certificates, even if correctly interpreted, you can never know the average number of comorbidities for a COVID death or any other primary cause of death. It could even be more than 4 for COVID, though that’s unlikely. In NSW death certificates, for example, there is space for no more than 2 conditions not directly in the chain of causes of death. It’s basically random whether the completing doctor thinks it’s relevant to put anything there - there is no effective quality control
My cousin died of Covid, caught mere weeks before he was eligible for the first vaccine as a front line physician. He was 70 years old but was absolutely killed by the virus.