This Viewpoint emphasizes the importance of accurate, detailed documentation of cause of death, underlying medical disease, and contributing comorbidities to allow public health agencies to track and manage the coronavirus disease 2019 (COVID-19) pandemic based on timely and accurate data.
The authors stress that accurate death certification related to COVID-19 is vital to understand the extent and progression of the pandemic, inform the public and policy makers on the progress of the pandemic ,and provide important information about who is dying, where they are from, and what were their associated medical conditions. But death certificate documentation in the US is not always accurate because they are typically completed by treating physicians, who are not trained in death certification.
Moreover, death certificate data often lack an accurate description of the underlying medical illness and contributory conditions. A US death certificate typically has 4 separate lines (part I) and is divided into sections: proximate cause, immediate cause, and mechanism. The proximate (underlying) cause is defined as the etiologically specific disease that in a natural and continuous sequence, uninterrupted by an efficient intervening cause, produced the fatality and without which the death would not have occurred. This must be included for it to be a competent death certificate. The contributing conditions section (part II) is for diseases that contribute to death but do not cause the disease listed in part I.
Every death certificate needs an etiologically specific (underlying) cause of death to be useful for public health and mortality surveillance. Part II findings are also essential for public health analysis of risk factors for deaths from COVID-19, as these become important discriminating factors, in addition to age, sex, race, and residence that are already included.
In order to improve the accuracy and quality of death certificate data, the authors suggest that all suspected and confirmed COVID-19 deaths should be reported to and examined by the medical examiner’s office. The medical examiner should collaborate with the department of public health by publishing and disseminating updated guidelines about which deaths need to be reported and what is acceptable death certificate terminology.
