U.S. toll varies depending on who’s counting

When the U.S. hit 1 million COVID-19 deaths on Monday, the news was driven by a government tally derived from death certificates.

But that’s not the only tally. Death certificates have long been considered the most comprehensive record of deaths and their causes. The Centers for Disease Control and Prevention systematically collects information from all 50 states to track fatalities from all causes, including cancer, drug overdoses and now COVID-19.

But early in the pandemic, officials recognized the COVID-19 data was sluggish and incomplete.

Testing was often unavailable. In some places — especially rural ones — coroners or medical examiners did not have the staff to ask about coronavirus symptoms when people died at home. Even when information was available, overworked doctors could be slow to do the death certificate paperwork.

With information on death certificates slow to arrive, experts and news organizations began looking to other real-time sources of deaths.

They turned to state health department tallies derived from preliminary reports that were mainly of people diagnosed with COVID-19 who went to a hospital and died. Such data was more timely than death certificates, which can take weeks to fill out and process.

Johns Hopkins University became a leader in searching state health department websites and rapidly analyzing and posting those numbers.

Other organizations have their own counts.

Last week, federal officials issued statements about the nation hitting 1 million deaths, even though the U.S. government’s own data had yet to show it. Based on lags in the reporting of death certificate information, officials concluded it was likely the milestone had passed and that it was appropriate to remark on it.

As the pandemic dragged on, many states cut back on posting case and death numbers — some to once a week.

As of Monday morning, the Johns Hopkins data portal counted 999,607 deaths. The CDC count based on death certificates was 1,000,292.

Some experts believe even the current death certificatebased data is an undercount. But it’s the best available, said Andrew Stokes, a Boston University researcher.

“It’s kind of the final say,” he said.