Clarifying the Count: How COVID-19 deaths are reported

SOUTH BEND, Ind. (WNDU) – COVID-19 has ravaged the United States with over 500,000 people having died from the virus. You’ve seen death totals reported daily, but what exactly is a COVID-19 death?

There is an arbitrary aspect to the process that you might not expect. You’ve seen the running death total but how is it determined that COVID is what killed a person. Many recover without much issue, but for some the coronavirus is too much. I spoke with doctors to learn what counts as a COVID death.

“It is an imperfect science,” Dr Mark Fox says. He is the Deputy Health Officer for the St. Joseph County Department of Health.

That’s a perfect way to describe the process of looking at what counts as a COVID death. You’ve seen the death toll rising but with almost no information as to how coronavirus deaths are determined. We’ll shed some light on the process.

“The deaths, I think are really, for the most part counted by way of death certificates.’ Dr. Dan Nafziger says. He is the Chief Medical Officer for Goshen Hospital. “Probably most of the COVID deaths that are being counted are where COVID appears in that chain of causation.”

So what is that chain of causation? When a person dies the attending physician will list a primary, secondary, and/or tertiary cause of death. For a coronavirus death, COVID-19 will appear on one of these lines, or on the other significant conditions portion.

“It probably isn’t going to be the primary cause of death in many cases because people will have respiratory failure or they’ll have pulmonary emboli. They’ll have other things that may result from the COVID but I’m guessing that generally people are counting COVID in that chain of events,” Dr. Nafziger says.

Where it appears on that chain of events, or if it appears at all, is up to that attending doctor, and not every doctor is the same.

“Whenever a person dies, the physician that pronounces them dead is responsible for completing the death certificate,” Dr. Nafziger says.

Factor’s like the doctor’s previous training and as well as clinical judgement come into play, so it’s up in the air if COVID makes it’s way onto the death certificate. It depends on whether or not that doctor believes COVID-19 played a role in the death. Asking questions like:

“Were it not for the COVID would they have died in this hospitalization or under these circumstances. Sometimes it is a matter of clinical judgement,” Dr. Fox says.

This isn’t to say that the death count isn’t real. It’s all too real, especially for families now missing loved ones. Still, conspiracies around COVID-19 have been a problem. The doctors I spoke with mention hearing of conspiracies about people dying of cancer, being hit by cars, or even shot and killed and being counted as a COVID death. Those theories are not quite accurate, but in those circumstances COVID, if present, could have played a role in the death.

“The conspiracy theorists say well he had cancer, he died of cancer, he just happened to also have COVID. It may be that, yeah, he happened to have COVID but really didn’t play a role in someone’s death. Again, a clinician might say, yeah, but if he didn’t have COVID he wouldn’t have died then, he would have died from his COPD, he would have died from his cancer, but it might have been our best guess is months down the line. It was accelerated because he had COVID,” Dr. Fox says.

Counting COVID deaths isn’t an exact science, and there is no uniform process for determining a COVID death. It’s a matter of putting trust in our healthcare system, and trusting the clinical determination of our doctors on the frontlines. If you think doctors are a part of some conspiracy to push the pandemic, here’s a message:

“It is a big lie, physicians don’t falsify death certificates. They do their best in completing death certificates. You know there may, there is, variation in how well people complete the death certificates but it’s not because they’re politically motivated. It’s not because they think they can create a pandemic if they just make it up on the death certificates, or that the pandemic will go away if they don’t put it on the death certificates. Physicians do their best to complete the death certificates, and they don’t lie about it,” Dr. Nafziger says.

Those death certificates tell a story, the final story, and writing that narrative is usually up to one doctor. Whether or not one of the characters in that final story is COVID-19, is up to that one doctor.

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