In your mom’s closet or in a shoe box under the bed, you might find a fancy-looking colored piece of paper that says “Birth Certificate” on it. Your parents probably got that birth certificate from the hospital right after you were born. In fact, if your neighbors or classmates were born at a hospital, they were given birth certificates too. So, if you wanted to know how many babies were born this month, you could go to all the hospitals and ask them how many birth certificates they made in the past 30 days.
Just as a birth certificate is made when a baby is born, a death certificate is made when someone dies. Even if a person doesn’t die at hospital, a doctor can examine the body and determine what caused the person’s death. That cause of death, along with other health problems the person had, are then written on the death certificate. So, if you wanted to know how many people died of COVID-19, you would count all the death certificates that listed “COVID-19” as a cause of death. But sometimes it can be tricky to know whether or not COVID-19 was the cause of death.
If someone dies in a hospital with pneumonia after testing positive for COVID-19, then COVID-19 is listed as the cause of death. That person might have also had diabetes or kidney problems, and those details are written on the death certificate, but not as a cause of death. If someone dies in a car accident and tests positive for COVID-19, the car accident is listed as the cause of death and COVID-19 is listed as a disease the person died with, not the disease they died of.
So far, this seems pretty straightforward. But it gets complicated for diseases that COVID-19 increases the risk of getting but doesn’t directly cause. For example, people who have tested positive for COVID-19 have increased risk of strokes and heart attacks, even if they have no lung issues. It’s also tricky if someone dies but their body can’t be tested for COVID-19. The family might report that the person had COVID-19 symptoms but, without a test, is that enough evidence to say that the person died of COVID-19? Early in the pandemic this was a big issue.
Even though it’s difficult sometimes to tell whether someone has died from COVID-19, agencies like the Center for Disease Control and Prevention (CDC) have written guides to help doctors decide. As we learn more about the disease and testing becomes easier, we get better at knowing if someone has died of COVID-19 and our counts become more accurate.