Some families, who have partisan views about COVID-19, may be unlikely to have pursued COVID-19 testing or to report a COVID-19 diagnosis.Īnd coroners, because they are elected, can have their own partisan bias.
Coroners’ offices also lack resources to investigate potential COVID-19 deaths in-person and often rely on information that families communicate to them. Most coroners have no medical training, and unlike medical examiners, they are not forensic pathologists. Outside of the medical setting, death certifiers, most often coroners, lack access to patient history or post-mortem COVID-19 tests, making it difficult to certify deaths. Physicians, who typically fill out death certificates in the hospital setting, can sometimes lack the appropriate knowledge of their patients to accurately assign cause-of-death. Due to this patchwork approach, inaccuracies occur in different ways in different settings. Once initial causes are recorded, the National Center for Health Statistics attempts to impose uniform standards in constructing a final set of causes, but all they have to work from is whatever was recorded by the death certifier. Who bears responsibility for a death certificate depends on where the death occurs - whether in a hospital or at home, as well as whether it occurs in counties that employ medical examiners or counties that rely on coroners. public health system, death reporting processes are decentralized. Multiple systemic failures have contributed to the current undercounting of COVID-19 deaths. There is also concern that COVID-19 deaths have been hidden in communities with more Black residents, indicating a potential pattern of structural racism in the death investigation system. represent uncounted COVID-19 deaths that the coronavirus directly caused or contributed to.įor example, investigative reporting has found significant irregularities in death certification practices across the U.S., especially in rural areas and across the South, where a higher proportion of COVID-19 deaths go uncounted. Nonetheless, evidence is mounting that many of the hidden deaths across the U.S. And some of the increases in deaths from natural causes like heart disease and diabetes also stem from the pandemic indirectly, such as when patients avoided hospitals because they feared infection or when health care was delayed in overcrowded hospitals. Increases in external causes of death - like drug poisonings, homicides and unintentional injuries - reflect the devastating effects of the pandemic on social and economic wellbeing. Not all hidden deaths are directly related to the SARS-Cov-2 virus.