I just reviewed the Federal Health and Human Service's guidelines for recording deaths. In summary:
1. If the patient had an underlying issue such as COPD, pneumonia, heart condition, diabetes, etc, those causes are to be listed first in order on the death certificate.
2. If it is known or strongly indicated that the person had Covid-19, it should be listed on the death certificate, below the other underlying conditions.
3. If the patient did not have another underlying condition and the person died from complications due to the Covid-19 virus as verified by a lab or if it is "probable" or "presumed" to be the cause, Covid-19 should be listed on a death certificate. If listing as "probable" or "presumed" the guidance says "the circumstances are compelling within a reasonable degree of certainty."
4. The guidance also states, " ... please note that testing for COVID19 should be conducted whenever possible."
You can read the full guidelines here:
Federal Government Covid-19 Death Reporting GuidelinesWhat the media are doing is tricky and this is the point of the article I read last night. They do not know the patients medical history and by law, they can not have access to the patient's medical records. As such, they must rely on what is listed on the death certificate. Personally, I think they need to avoid making assumptions, even when they suspect Covid-19 contributed to the person's death, unless they have other knowledge about the patient's immediate medical history.
I will continue to rely and track the numbers being published by the NCDHHS website. They are reporting what the county health departments are reporting and there can be a lag in reporting, due to a need to wait for a lab reports to come back. The media are not waiting for the final lab reports and this is why their counts in some cases are higher for a period of time than what the state is reporting. When the lab reports are returned, the state catches up to the media's reporting. However, I do not think the state's numbers will ever match the media's numbers, unless the state changes their guidelines.
I do understand the media's desire to have the most accurate death count possible. I want to have this information and I would like for it to be as timely as possible, so we could accurately track the curves for cases and deaths. However, I would say the media needs to be cautious to not include any death that they suspect, if they do not have a good indication of the patients immediate medical history.