Every Body Counts: Measuring Mortality From the COVID-19 Pandemic

Ann Intern Med. 2020 Dec 15;173(12):1004-1007. doi: 10.7326/M20-3100. Epub 2020 Sep 11.


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.

Publication types

  • Review

MeSH terms

  • COVID-19 / mortality*
  • Cause of Death / trends
  • Humans
  • Pandemics*
  • Registries*
  • SARS-CoV-2*
  • Survival Rate / trends