COVID-19 vs. complications of COVID, as explained by doctors.

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The family of Colin Powell announced on Monday that the former US Secretary of State has died from complications of COVID-19.

"General Colin L. Powell, former US Secretary of State and Chairman of the Joint Chiefs of Staff, passed away this morning due to complications from Covid-19. He was fully vaccinated," a family statement posted to Facebook says. "We want to thank the medical staff at Walter Reed National Medical Center for their caring treatment. We have lost a remarkable and loving husband, father, grandfather, and a great American."

Powell, who was 84, had multiple myeloma, a form of blood cancer that decreases the ability to fight infections, per NBC News.

Colin Powell death COVID-19 complications , Colin Powell at his home in Virginia. Powell is an American statesman and a retired four-star general in the United States Army. He was the 65th United States Secretary of State, serving under U.S. President George W. Bush from 2001 to 2005, the first African American to serve in that position. (Photo by Brooks Kraft LLC/Corbis via Getty Images)
Credit: Brooks Kraft LLC/Corbis via Getty Images

Powell's death has raised some questions about what it means to die from complications of COVID-19 and dying from the virus itself. Both terms have been used when someone passes away and COVID-19 is involved—but how are they different?

It depends, William Schaffner, MD, an infectious disease specialist and professor at Vanderbilt University School of Medicine, tells Health. Some people use the terms interchangeably, while others actually imply something different when they use them. "Some people talk about dying of the complications of COVID when they really mean very serious COVID and all of the complications of the virus that happen outside of the lungs," he says. "Other people would just call that a severe form of COVID."

Infectious disease expert Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, agrees. "There really isn't a distinction," he tells Health. "It's usually just the way people speak about it. Dying from COVID and dying from COVID complications, for all intents and purposes, is the same thing."

While people tend to flip between the terms, Dr. Adalja says there may be some situations where someone could actually die from complications of COVID-19. "There could be a case of someone who had COVID was in the ICU for several weeks, got discharged home, never got back to their baseline, and ended up dying at home," he says.

"People who have a lot of chronic or severe underlying health conditions could get COVID and then die from something like a blood clot or myocarditis." (Myocarditis is an inflammation of the heart muscle and can lead to complications like heart failure, heart attack, stroke, or sudden cardiac death.)

While Powell's family didn't mention his history with blood cancer in their statement, their use of "complications from COVID" may have been quietly referring to it.

People with COVID-19 can also develop bacterial pneumonia on top of COVID pneumonia, which is viral, Dr. Schaffner says. That technically could be considered a complication of COVID-19, he says.

"It could be different, but there's a fuzzy line here," Martin J. Blaser, MD, professor of medicine and pathology and laboratory medicine at the Rutgers Robert Wood Johnson Medical School, tells Health.

Deaths from COVID-19 and complications of COVID-19 are "not recorded differently" by doctors, John Sellick, DO, an infectious disease expert and professor of medicine at the University at Buffalo/SUNY, tells Health. "You see this big group of people who have COVID and have a heart attack or a stroke...is it the COVID? Is it a complication of COVID? It can be hard to parse these things out."

Ultimately, Dr. Adalja points out, "You don't die from a mild case of COVID. Every case is going to have complications." Dr. Blaser also notes that "sometimes the terminology is not quite precise but, unfortunately, the end result is the same."

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