“The case definition is very simplistic,” Dr. Ngozi Ezike, director of Illinois Department of Public Health, explains. “It means, at the time of death, it was a COVID positive diagnosis. That means, that if you were in hospice and had already been given a few weeks to live, and then you also were found to have COVID, that would be counted as a COVID death. It means, technically even if you died of clear alternative cause, but you had COVID at the same time, it’s still listed as a COVID death.”

Medical examiners in Michigan use the same definition. In Macomb and Oakland Counties, where most of the deaths occurred, medical examiners classify any deaths as Coronavirus deaths when the postmortem test is positive. Even people who died in suicides and automobile accidents meet that definition.

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Still, these broad definitions are not due to a few rogue public health officials. The rules direct them to do this. Unlike other countries, “if someone dies with COVID-19, we are counting that as a COVID-19 death,” as Dr. Deborah Birx, the White House coronavirus response coordinator, recently noted.

Classifications go beyond even these broad categories. New York is classifying cases as Coronavirus deaths even when postmortem tests have been negative. Despite negative tests, classifications are based on symptoms, even though the symptoms are often very similar to those of the seasonal flu.

There are financial incentives that might make a difference for hospitals and doctors. The CARES Act adds a 20 percent premium for COVID-19 Medicare patients.

Incentives matter. When the government increased the disability compensation for air traffic controllers, a lot more controllers suddenly started claiming to be disabled. When unemployment insurance payments increase, more people become unemployed and stay unemployed for longer periods. When the government offers flood insurance that charges everyone the same insurance premium regardless of the risk level in their area, more people build homes in frequently flooded areas.