Every Body Counts: Measuring Mortality From the COVID-19 Pandemic
Open accessAbstract
As of mid-August 2020, more than 170 000 U.S. residents have died of coronavirus disease 2019 (COVID-19); however, the true number of deaths resulting from COVID-19, both directly and indirectly, is likely to be much higher. The proper attribution of deaths to this pandemic has a range of societal, legal, mortuary, and public health consequences. This article discusses the current difficulties of disaster death attribution and describes the strengths and limitations of relying on death counts from death certificates, estimations of indirect deaths, and estimations of excess mortality. Improving the tabulation of direct and indirect deaths on death certificates will require concerted efforts and consensus across medical institutions and public health agencies. In addition, actionable estimates of excess mortality will require timely access to standardized and structured vital registry data, which should be shared directly at the state level to ensure rapid response for local governments. Correct attribution of direct and indirect deaths and estimation of excess mortality are complementary goals that are critical to our understanding of the pandemic and its effect on human life.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Correctly accounting for deaths and their causes during acute emergencies carries important societal ramifications.
“Correctly accounting for deaths and their causes during acute emergencies carries important societal ramifications9–12.”
From Attributed causes of excess mortality during the COVID-19 pandemic in a south Indian city (2023) · cites this paper as [10]
Cites
Mortality in Puerto Rico after Hurricane Maria
Kishore, N., Marqués, D., Mahmud, A. S., Kiang, M. V., Rodriguez, I., Fuller, A., Ebner, P. J., Sorensen, C. J., Racy, F. D. C. J., Lemery, J. M., et al. (2018) · New England Journal of Medicine · doi:10.1056/nejmsa1803972 · Cited by 706 · see citing works
Self-citationVariation in COVID-19 Hospitalizations and Deaths Across New York City Boroughs
Wadhera, R. K., Wadhera, P., Gaba, P., Figueroa, J. F., Maddox, K. E. J., Yeh, R. W., & Shen, C. (2020) · JAMA · doi:10.1001/jama.2020.7197 · Cited by 650 · see citing works
Excess deaths from COVID-19 and other causes, March–April 2020.
Woolf, S. H., Chapman, D. A., Sabo, R. T., Weinberger, D. M., & Hill, L. (2020) · JAMA · doi:10.1001/jama.2020.11787 · Cited by 541 · see citing works
Weinberger, D. M., Chen, J., Cohen, T., Crawford, F. W., Mostashari, F., Olson, D., Pitzer, V. E., Reich, N. G., Russi, M., Simonsen, L., et al. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.3391 · Cited by 485 · see citing works
Death Certification Errors and the Effect on Mortality Statistics
McGivern, L., Shulman, L. P., Carney, J. K., et al. (2017) · Public Health Reports · doi:10.1177/0033354917736514 · Cited by 234 · see citing works
Interim measures for meeting needs for health sector data: births, deaths, and causes of death
Hill, K., López, A. D., Shibuya, K., & Jha, P. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61309-9 · Cited by 145 · see citing works
Tappero, J. W., & Tauxe, R. V. (2011) · Emerging infectious diseases · doi:10.3201/eid1711.110827 · Cited by 124 · see citing works
Combs, D. L. (1999) · International Journal of Epidemiology · doi:10.1093/ije/28.6.1124 · Cited by 114 · see citing works
The Importance of Proper Death Certification During the COVID-19 Pandemic
Gill, J. R., & DeJoseph, M. E. (2020) · JAMA · doi:10.1001/jama.2020.9536 · Cited by 82 · see citing works
Science and politics of disaster death tolls
Guha‐Sapir, D., & Checchi, F. (2018) · BMJ · doi:10.1136/bmj.k4005 · Cited by 56 · see citing works
Green, H. K., Lysaght, O., Saulnier, D. D., Blanchard, K., Humphrey, A., Fakhruddin, B. S. H. M., & Murray, V. S. G. (2019) · International Journal of Disaster Risk Science · doi:10.1007/s13753-019-00237-x · Cited by 56 · see citing works
Choudhary, E., Zane, D., Beasley, C., et al. (2012) · Prehospital and Disaster Medicine · doi:10.1017/s1049023x12000957 · Cited by 25 · see citing works
Death, statistics and a disaster zone: the struggle to count the dead after Hurricane Maria
Arnold, C. (2019) · Nature · doi:10.1038/d41586-019-00442-0 · Cited by 16 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Socioeconomic status determines COVID-19 incidence and related mortality in Santiago, Chile
Mena, G. E., Martinez, P. P., Mahmud, A. S., Marquet, P. A., Buckee, C. O., & Santillana, M. (2021) · Science · doi:10.1126/science.abg5298 · Cited by 431 · see citing works
Self-citationAttributed causes of excess mortality during the COVID-19 pandemic in a south Indian city
Lewnard, J. A., B, C. M., Kang, G., & Laxminarayan, R. (2023) · Nature Communications · doi:10.1038/s41467-023-39322-7 · Cited by 23 · see citing works
- Authors
- Kiang, M. V., Irizarry, R. A., Buckee, C. O., & Balsari, S.
- Affiliations
- Stanford Medicine (US)
- Dana-Farber Cancer Institute (US)
- Harvard University (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2020-12-15
- Volume
- 173
- Issue
- 12
- Pages
- 1004-1007
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- PMC
- PMC7505023
- OpenAlex
- W3086116031
- Cited by
- 96
- References
- 13
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 17 · 2023: 17 · 2022: 27 · 2021: 23 · 2020: 4
- FWCI
- 2.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion)
- Funders
- National Institute on Drug Abuse (K99DA051534)
- National Institute of General Medical Sciences (R35GM131802)
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Keywords
- COVID-19 mortality, death certificates, excess mortality
- MeSH terms
- COVID-19, SARS-CoV-2, Cause of Death, Humans, Registries, Survival Rate, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
