How does VDH Count COVID-19-Associated Deaths?

The Virginia Department of Health (VDH) is counting the number of deaths associated with COVID-19 to understand the impact of the COVID-19 pandemic. VDH is drawing on experience counting deaths for other reportable conditions in order to be as accurate as possible. For some health conditions, there is a national standard for how to count deaths as disease-associated mortality. Influenza-associated pediatric mortality and RSV-associated mortality are good examples of these conditions. For other conditions, the national standard for which situations get counted applies to the case itself. Identifying which cases are fatal becomes part of the case investigation. This might occur through medical record review, discussion with the patient’s healthcare provider, or death certificate review. 

The COVID-19 standardized case definition outlines which cases get counted, but it does not outline which deaths get counted. To help understand the impact of COVID-19, VDH developed a standardized definition for how Virginia counts COVID-19-associated deaths. VDH counts a COVID-19-associated death if it meets one of the three criteria below:

  1. During the case or outbreak investigation, the case investigator determined that the patient passed away due to COVID-19. This may occur through medical record review, talking with the patient’s healthcare provider, or talking with their family.
  2. VDH receives a death certificate that matches a known case of COVID-19 and either:
    1. The death certificate specifically lists COVID-19 or SARS-CoV-2, or
    2. The death certificate lists a directly related cause of death (examples include acute respiratory distress syndrome, viral pneumonia, and hypoxic respiratory failure), the death occurred within 60 days of the patient becoming sick, and there’s no evidence of recovery between illness onset and death.
  3. VDH receives a death certificate that does not match a known case of COVID-19 and the death certificate specifically lists COVID-19 or SARS-CoV-2 as a direct or contributing cause of death. These situations are entered as a new case that resulted in death.

If a death certificate lists a cause of death that fully explains the patient’s death, then VDH does not count it as a COVID-19-associated death. Examples of this include suicide, gunshot wounds, motor vehicle accidents, and overdose. VDH is counting people who died due to COVID-19, not people who died of some other cause while also having COVID-19.

Many of the deaths that VDH reviews have underlying conditions like diabetes, heart disease, or dementia. VDH only counts deaths among people with these conditions as COVID-19-associated if the patient’s medical record, healthcare provider, or death certificate specifically indicates that they died due to COVID-19 or an acute respiratory complication of COVID-19. If a person with COVID-19 passes away, their healthcare provided does not tell us the death was COVID-19-related, and the death certificate lists something like cancer or end stage renal failure, then VDH does not count that death as COVID-19-associated.

VDH does count deaths among people with underlying conditions where the death certificate specifically lists that COVID-19 was an immediate or contributing cause of death. Many of these death certificates may also list the underlying condition. In these situations, it is likely that the COVID-19 infection worsened the underlying condition and the two together contributed to the patient’s death. 

Some helpful things to remember about COVID-19-associated deaths:

  • Death is one possible outcome of a COVID-19 case. The number of deaths reported by VDH is a subset of the number of COVID-19 cases.
  • Probable deaths are deaths that occurred in probable cases.
  • There can be a delay between a peak in cases and a peak in deaths.
    • This is partly due to the progression of the disease – on average, death occurs a week or more after illness onset.
    • Each death is reviewed by a subject matter expert which takes additional time. 
  • Trends in the number of deaths reported over time represent the time VDH is able to dedicate to entering those data. They do not represent when deaths occurred.
  • There is the option to view VDH’s data on COVID-19-associated deaths by the date of death here, which is more accurate than looking at deaths by the day reported.