In light of the issues around deaths reported by Minnesota, I want to again run through the typical process for how deaths are reported and what the lags may be. While Minnesota is the example, the process is pretty much the same everywhere. When a person dies, someone fills out and sends to the state health department a standard form death certificate. There is a recommended standard form from the WHO and from the CDC and the state forms tend to very closely follow these forms. The state of Minnesota gives instructions to those who complete the death certificates. There are codes, from the ICD, or International Classification of Diseases, system that are used to describe causes and contributing conditions for death. In a pretty unprecedented move, the CDC issued specific guidance on CV-19, encouraging assigning any death where the decedent was in the same universe as the virus to CV-19. Okay, maybe not that bad, but close. You can easily find all this stuff on line.
While the physician with the most knowledge of the case would be the ideal person to fill out a death certificate, I think that rarely happens. It may often even be a clerical person. In some cases people at funeral homes do it. Because there is not a standardized person or process for doing it, there is immense variation in how these certificates are filled out. That is why I gave up on analyzing the CV-19 death certificates in Minnesota. Eventually people will and should do an audit of the death certificates, looking at medical records, and determine in a more consistent way what the actual causes of and contribution to death were. Meanwhile we are stuck with the inconsistent and overly broad assignment of deaths to CV-19.
The person who fills out the death certificate then sends it to the state Department of Health. The state Department of Health records and retains the information. It also sends it on to the CDC, which is the repository of official death statistics for the United States. I believe the information is communicated in electronic form. So the lags in reporting are obvious. How long does it take the certifying person to get the form to the state. How long does it take the state to process the form. How long does it take the state to pass it on to the CDC. How long does it take the CDC to process the information. I believe Minnesota is actually one of the faster reporting states and in general, to help maintain the hype, states are reporting CV-19 deaths fairly quickly. Once the form is in, it can still be revised and that is happening with CV-19. Many states are engaged in after-the-fact matching, in which they look at test results and assign CV-19 as a cause of death even if the test was weeks or months before the death. That is how we get bizarre things like several thousand deaths nationally that were suicides, homicides or accidents being listed as CV-19 deaths. Most people have no idea what goes on with CV-19 deaths. If the certificate is revised, then the whole process starts over again.
The CDC has a spreadsheet, available to anyone, of CV-19 deaths and other information, by state and by week. It is based on the week of death, so it is accurate in that regard. You can find that here. (CDC Link) Just go to the section that says deaths by state and week and click and you will get to the spreadsheet which you can download and then you can filter to Minnesota. Every day of the work week, the CDC adds deaths it receives that day. As I mentioned yesterday, instead of pulling this every few weeks, I am going to start looking every day for a while, to show how deaths get scattered over several weeks. Hope this helps understand death reporting.
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at 
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The clerks doing medical coding are trained to “code for reimbursement.”
Here’s a non-CV19 example: My brother died of cancer 14 months ago. He was diagnosed with cancer after exploratory surgery – surgery was done when a colonoscopy could not go far enough to see the entire tract. I spoke with the surgeon minutes after surgery – he said the tumor was at the appendix and was large enough to cause pressure on the intestines which is why the colonoscopy could not go far enough. He said he was not skilled enough to remove the tumor without risking damage to other organs and we started looking for more specialized surgeons. He also said cancer of the appendix is very rare.
To make a long story short, the death certificate says “colon cancer.” My brother had retired about two months prior to surgery and was transitioning from COBRA to Medicare. My sister was handling the insurance end of things, so I don’t have full knowledge of how all that went, but it seemed to me all the caregivers just wanted to have it coded as colon cancer because it is common enough – coding it as appendix cancer would raise questions and require time from multiple physicians when insurance and Medicare start asking questions because it is so rare. So my brother is an “official” colon cancer death which made me wonder from that point on just how accurate the official CDC data has been.
Congress expediting CV19 reimbursement only makes me doubt the CDC statistics even more. Incentives matter – data accuracy is not an incentive and should not be assumed.