On COVID-19 Provisional Death Data
(and the Weather Report Team’s decision to discontinue routine death reporting)
The week following the end of the Public Health Emergency, the number of COVID deaths reported by the CDC dropped from 1000 to 300. What is going on? This info-sheet aims to explain why we made the decision to stop routine reporting of death data following the end of the Public Health Emergency (PHE) on May 11th 2023.
In our weekly Weather Report, The People’s CDC previously reported on trends in COVID-related deaths. We regularly noted that death data trailed cases and hospitalizations, oftentimes by two weeks or more. It was never used to forecast outbreaks or to understand transmission. Instead, death data allowed for us to comment on the severity of COVID strains and to recognize the ultimate losses caused by the virus (and the failures of the public health response).
What Changed?
Since May 2023, our readers may have noticed an absence of death data being routinely presented in our weekly Weather Reports, and may be wondering why we have not been providing analysis or reporting on current COVID-related deaths. The answer: this data is no longer reliable.
In short, the PHE allocated funding to create and maintain a surveillance system, which would speed up the processing of death certificates that were flagged as COVID-related deaths. That system has been eliminated. The CDC has now transitioned to “provisional death data,” and moved COVID death reporting into the CDC’s National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS). The consequence: massive delays in reporting– sometimes up to 2 months.
What is the process for capturing death data?
The process from the occurrence of a death to the reporting to a national database is lengthy: verification, checks, and edits to a death certificate are routinely made to ensure the most accurate data is provided on a death certificate. It can take several weeks or months for data to be added to the NVSS.
The process typically begins with a medical examiner, coroner, licensed physician, or funeral director (depending on local jurisdiction) completing the death certificate. This process is not standardized across states, and, depending on the state, is not even standardized across counties. In some cases, laboratory tests or autopsy results may be required to determine the cause of death, which can result in the delay of a death certificate being completed. The CDC notes that 85% of death certificates are completed within 4 weeks of occurrence.
Once a death certificate is completed, it is typically sent to the local jurisdiction (eg. a county health department) and then forwarded to the state’s vital statistics unit or equivalent department. These data are then processed at the state level before a query is made by NCHS. The NCHS is also responsible for further processing, cleaning, and managing data that comes from each state before it can be queried for the COVID Data Tracker. In the footnotes of the COVID Data Tracker, it is noted that the delay can range “from 1 week to 8 weeks or more depending on the jurisdiction.” The CDC reports that depending on the state where the death occurred, between 1% and 75% of death certificates are reported within 10 days of the date of death.
What do we have to analyze?
The COVID data tracker reports a weekly count of deaths. At face value, we might assume that this is timely and actionable data—that the deaths are reported the week that they occurred. But, since these data suffer delays mentioned above, we will see increases in deaths long after deaths have increased. We have been hesitant to routinely report deaths as a part of our timely updates, but will occasionally report updated death data in order to recognize the ongoing threat of the virus.
What we do know is that Americans, mostly working-class, poor, disabled and older people, continue to suffer death from the ongoing COVID pandemic. COVID remains the third leading cause of death in the US. We mourn all those who have died due to COVID, and in that mourning, call upon you to take measures to prevent death and disablement for yourself, your loved ones, and your communities.