How does VDH Count COVID-19-Associated Deaths?

The Virginia Department of Health (VDH) counts 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 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. For other conditions, the national standard for which situations get counted applies to the case itself. Identifying which cases result in death becomes part of the case investigation. This might occur through review of a medical record, discussion with the patient’s healthcare provider, or through review of the patient’s death certificate. 

The COVID-19 standardized case definition outlines which cases and deaths get counted. VDH counts a COVID-19-associated death if it meets one of the three criteria below:

  1. During the case investigation, the case investigator determined that the patient passed away due to COVID-19. This may occur through the review of the patient’s medical record, talking with the patient’s healthcare provider, or talking with the patient’s family.
  2. VDH receives a death certificate that matches a known confirmed or probable case of COVID-19 and either:
    • The death certificate specifically lists COVID-19 or SARS-CoV-2 as the primary or contributing factor in death, or
    • 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 the date the patient became sick and the date of death.
  3. VDH receives a death certificate that does not match a known confirmed or probable case of COVID-19 and the death certificate specifically lists COVID-19 or SARS-CoV-2 as the primary or contributing cause of death. These situations are entered as new probable cases that resulted in death.

Even for known confirmed and probable COVID-19 cases, if a death certificate lists an alternative cause of death that better fully explains the patient’s death, VDH does not count that person as a COVID-19-associated death. Examples include suicide, gunshot wounds, motor vehicle accidents, and drug overdose. VDH only counts people who died as a result of COVID-19, not people who died of another more directly related cause while also having COVID-19.

Many deaths that VDH reviews are people that have underlying conditions like diabetes, heart disease, or dementia. VDH only counts people as COVID-19-associated deaths if the person’s medical record, healthcare provider, or official death certificate indicates that they died due to COVID-19 or as a result of an acute respiratory complication related to COVID-19. If a person with COVID-19 dies and their healthcare provider does not tell us the death was COVID-19-related and the death certificate lists something like cancer or end stage renal failure as the only cause of death, 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 as the primary or contributing cause of death. Many of these death certificates 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 infection. The number of deaths reported by VDH is a subset of the total number of COVID-19 cases.
  • Probable deaths are deaths that occurred in persons classified as probable COVID-19 cases.
  • There is a delay between a rise in cases and a corresponding rise in deaths.
    • This is partly due to the progression of the disease – on average, death occurs a week or more after a person becomes sick with COVID-19.
    • Each death certificate is reviewed carefully according to stringent criteria by a subject matter expert which takes additional time. 
  • Graphs showing the number of deaths reported by day does not represent when a death occurred.
  • There is the option to view VDH’s data on COVID-19-associated deaths by the date of death here, which is a more accurate representation of when death occurred than looking at deaths by the day they were reported.


*Originally posted on January 11, 2021.