Dr. Phlip McMillan,  John McMillan

Vaccine hesitancy is making headlines again. Measles outbreaks are returning in places where they were once wiped out, and officials are quick to pin the blame on the unvaccinated. But is the story that simple?

In the mid to late 1980s, at the height of the HIV/AIDS epidemic, overwhelmed clinicians struggled to accurately attribute deaths. Many patients succumbed to opportunistic infections like Kaposi’s sarcoma or pneumonia, yet the underlying immunosuppression from HIV wasn’t always identified as the primary cause. This presented a complex medical challenge: not just in treatment, but in definition. When a novel virus ravages the immune system, leaving individuals vulnerable to secondary infections, overlapping conditions, and ambiguous pathology, the line between cause and coincidence blurs.

Decades later, Greece is facing a similar diagnostic dilemma: this time with COVID-19.

When COVID swept across the globe, it didn’t just infect bodies. It infected our data. A recent study from several Athens hospitals now challenges long-held assumptions behind the country’s pandemic death statistics. It poses a deceptively simple question: how many people listed as COVID-19 fatalities actually died from the virus? The answer may be more unsettling than expected.

Rethinking the Count

Researchers reviewed 530 in-hospital deaths initially registered as COVID-19 fatalities across seven major hospitals in Athens. This covered the period from January to August 2022, during the dominance of the Omicron variant. The methodology included a review of death certificates, clinical notes, and interviews with attending physicians. Their aim was to determine whether COVID-19 caused the death, contributed to it, or was merely incidental.

The results were quite disturbing. Nearly half of the recorded COVID-19 deaths (45.3%) were reclassified as not directly attributable to the virus. These were deemed deaths with COVID-19: cases where the virus was present, but not the primary cause. Only 25% were identified as clear-cut COVID-19 deaths, while the remaining 30% involved the virus as a contributing factor, not the principal one.

This reassessment took place during the Omicron wave, a time when the virus, though highly transmissible, caused milder respiratory symptoms than earlier, more severe variants like Delta.

Behind the Numbers: Deaths With COVID

So what did cause death in the 240 individuals who died with COVID-19, but not from it? Many had entirely different primary causes of mortality: septic shock, aspiration pneumonia, various cancers, kidney failure, stroke, and heart failure.

In many cases, COVID-19 was discovered incidentally. Patients were admitted for unrelated procedures (such as surgery, cancer treatment, or dialysis) and tested positive during routine screening. This aligns with findings showing that a substantial portion of this “with COVID-19” group, including 78 patients, never required oxygen therapy. Few had respiratory symptoms. Fewer still received any COVID-specific treatment. Notably, nearly 30% contracted COVID-19 within the hospital.

These were not deaths from respiratory failure or pneumonia. Most didn’t even require oxygen support.

The Role of Vaccination and the Autoimmunity Hypothesis

The Athens study, like many during the pandemic, grouped unvaccinated and partially vaccinated individuals into a single category. This approach has drawn criticism. Dr Philip McMillan, a clinician and researcher, challenges the validity of this method:

“I don’t know why they think that somebody who had one vaccine is unvaccinated. They are not… It skews your numbers and it makes it appear that the data you are bringing is trying to support a specific narrative rather than being factual.”

Indeed, the data showed that 63.3% of “with COVID-19” deaths occurred in fully or booster-vaccinated individuals, a group that made up roughly 75–77% of the general population during that period.

This has led some clinicians to propose alternative frameworks. Dr McMillan, who independently reviewed the same dataset, suggests that repeated exposure to the spike protein (whether via infection or vaccination) may trigger immune dysregulation in certain individuals, potentially exacerbating existing conditions or initiating new ones.

He refers to this as the “COVID storm”: a process in which immune priming, recurring exposure, and underlying vulnerabilities intersect in unpredictable and sometimes dangerous ways.

“Just reflect on what happens if the spike protein is driving the immune system to go into overdrive and attack itself,” Dr McMillan said. “That’s when it gets serious.”

While this autoimmune hypothesis remains under investigation, it offers one possible explanation for why COVID-19-associated mortality remained elevated even after respiratory symptoms became less severe.

The Bigger Picture: Greece’s Mortality Trends

From 2015 to 2019, Greece recorded an annual average of 121,800 deaths. That number jumped to 143,600 in 2021 (during the Delta wave) and remained high in 2022 at 140,300, despite the dominance of a milder variant and widespread vaccine rollout. Even into 2023 and 2024, the death toll stayed above pre-pandemic levels.

In fact, the average number of deaths from 2022 to 2024 settled around 131,381, roughly 9,582 more deaths per year than the baseline. This sustained increase raises difficult questions. If vaccines were highly effective and the virus had weakened, why didn’t mortality rates return to normal?

The answer may not lie in a single variable, but in the complexity of immune responses, hospital protocols, treatment side effects, and data classification practices.

Learning from the Past

The AIDS epidemic taught the medical world the importance of diagnostic context. Counting every HIV-positive death as an AIDS death would have distorted the truth and undermined public trust. In both instances (AIDS and COVID-19) a novel virus created overlapping pathologies that made cause-of-death attribution unusually difficult. Over time, improved understanding and refined reporting practices brought clarity. The same lesson now applies to COVID-19.

The Athens study presents compelling evidence of over-reporting direct COVID-19 deaths during the Omicron surge. Coupled with persistently elevated mortality, these findings call for reporting systems that move beyond simplistic death tallies based solely on positive SARS-CoV-2 tests.

“This is about narratives, not about science,” said Dr McMillan. “That approach to medicine is wrong.”

The Greek data doesn’t offer easy answers. But it underscores the need for honest, granular assessments of mortality. Without them, we risk mistaking correlation for causation and losing public confidence in the process.

In a post-pandemic world, clarity isn’t just a scientific responsibility. It’s a moral one.