How do we know how many people have died of COVID?

With all the talk about how many people have died of COVID-19, there have been a lot of questions about how vital statistics are created. Vital statistics refer to the number of births and deaths, as well as the number of people who die from a specific cause.


When someone dies, whether at home or in a hospital, a death certificate is filled out.  This certificate can be completed by a medical examiner, a coroner, or the doctor with responsibility for the patient at the time of death.  For each death certificate, the doctor documents the chain of events and underlying conditions that directly led to the death.  

If someone dies of pneumonia caused by COVID-19, both conditions would be listed on the death certificate with COVID-19 as the cause of death.  If this person also had diabetes, diabetes would be listed as a significant condition contributing to the death, but not the cause of death.  This person would be counted as having died of COVID-19.

In contrast, suppose someone who tested positive for COVID-19 was killed in a car accident.  The car accident would be the cause of death.  This person would be counted as having “died with” COVID, not as having “died of” COVID.

There are more challenging cases.  For example, COVID-19 seems to cause an increase in heart attacks.  If someone dies of a heart attack with COVID-19, it is up to the professional judgement of the physician completing the death certificate to determine if COVID-19 caused the heart attack.

Many are concerned that we are over counting deaths due to COVID.  However, comparing all-cause mortality data from previous years to 2020, the number of excess deaths is higher than the number of deaths from COVID.  This suggests that, if anything, we are under counting the number of COVID deaths.


Last update: September 25, 2020, 9:37 pm ET

Science review: JAB, ERS