Every Body Counts: Measuring Mortality From the COVID-19 Pandemic

Abstract

As of mid-August 2020, more than 170 000 U.S. residents have died of coronavirus disease 2019 (COVID-19); however, the true number of deaths resulting from COVID-19, both directly and indirectly, is likely to be much higher. The proper attribution of deaths to this pandemic has a range of societal, legal, mortuary, and public health consequences. This article discusses the current difficulties of disaster death attribution and describes the strengths and limitations of relying on death counts from death certificates, estimations of indirect deaths, and estimations of excess mortality. Improving the tabulation of direct and indirect deaths on death certificates will require concerted efforts and consensus across medical institutions and public health agencies. In addition, actionable estimates of excess mortality will require timely access to standardized and structured vital registry data, which should be shared directly at the state level to ensure rapid response for local governments. Correct attribution of direct and indirect deaths and estimation of excess mortality are complementary goals that are critical to our understanding of the pandemic and its effect on human life.

Figure.. Schematic representation of deaths due to the COVID-19 pandemic.

Early in the pandemic, deaths not directly attributed to COVID-19 included unrecognized deaths from severe acute respiratory syndrome coronavirus 2 (white band) because of evolving case definitions and inadequate testing. As the pandemic continues, it is likely that they will include a greater proportion of indirect deaths (dark green band) from disruptions to society and health systems caused by the pandemic. COVID-19 = coronavirus disease 2019.