Interestingly I've read that heart attack and stroke deaths have been down during the COVID-19 crisis. It seems at least some of the COVID-19 deaths (pre-existing conditions) may have does anyway without the virus.
Not really hard to understand. COVID in itself doesn't kill, it's underlying effects on (potentially already diseased) organs that cause death -- most commonly double pneumonia in the lungs, heart attack and brain stroke.
While these patients might have been ripe to rack up their death statistics in one of the other categories, they got COVID which acted as a catalyst and stressed their often already diseased organs and immune systems. They kicked the bucket while positive for COVID. It's likely many of these positive testing patients were considered COVID deaths, even though their failing organs took then out.
Now the moral dilemma.
In these cases is the death certificate inaccurate? Tough call.