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

A new article, published today in the Annals of Internal Medicine, examines how relying solely on death certificate data can result in an underestimate of COVID-19 mortality rates, making it difficult to assess the true toll of the pandemic.

The article’s authors, FXB Center Fellow Mathew Kiang, Harvard T.H. Chan School of Public Health Professors Rafael Irizarry and Caroline Buckee, and FXB Center Fellow Dr. Satchit Balsari, propose ways to address the current difficulties in attributing disaster deaths and in accurately estimating pandemic-related mortality.

An Annals of Internal Medicine summary of the article can be found below. To read the article in full, click here.


Counts based on death certificates underestimate COVID-19 mortality rates

Researchers suggest ways to address challenges associated with measuring direct and indirect deaths attributable to COVID-19 pandemic

Estimating deaths from COVID-19 based on death certificate data significantly underestimates the true mortality rate of the pandemic.  Authors from Stanford University School of Medicine, Dana-Farber Cancer Institute, Harvard T.H. Chan School of Public Health, and Harvard Medical School describe how methods used to assess death tolls from disasters and other pandemics can be used to provide a more accurate picture of COVID-19 death rates now and moving forward. This means measuring direct, indirect, and excess deaths from COVID-19. Their proposed solution is published in Annals of Internal Medicine. Read the full text.

Overcoming challenges when calculating direct deaths will require a consensus among health care institutions, medical examiners, and public health agencies. The authors endorse counting all deaths from pneumonia, influenza-like illness, and COVID-19 and subtracting the expected seasonal number of cases of pneumonia and influenza computed from trends in the previous 5 years, as currently done by the Centers for Disease Control and Prevention (CDC). To calculate indirect deaths, the researchers recommend employing the CDC’s “but for” principle, which is used when ascertaining disaster-related deaths: “But for the [pandemic], would the person have died when he/she did?” Expected recommendations from the National Academies of Sciences, Engineering, and Medicine, could help with this. And to calculate excess deaths, publicly available, well-curated historical data, with published application programming interfaces is needed. According to the authors addressing these issues is critical to our understanding of the pandemic and its effect on human life.

The author of an accompanying editorial from Merck & Co. agrees that reliable and timely information about both direct and indirect mortality attributable to the COVID-19 pandemic is essential. The most accurate data to assess mortality in the United States from any cause are derived from the National Vital Statistics System (NVSS). Seeing as these data are vital to informing health and emergency preparedness systems in the United States, they are worth greater investment.  Read the full text.

Media contacts: A PDF for this article is not yet available. Please click the link to read full text. The authors can be reached through Veronica Lewin at The editorialist, Julie Louise Gerberding, MD, MPH, can be reached at