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Why you don’t see COVID-19 on death certificates

Novel coronavirus among communicable diseases not publicly released on death certificates

  • 3 min to read


Some have questioned why COVID-19 doesn’t appear on publicly-disclosed death certificates, and it’s because the cause is being redacted as part of a long-standing practice relating to certain communicable diseases.

As many know, vital records, such as death certificates, often are disclosed publicly, and they’re printed in newspapers such as this one. Many have noticed that COVID-19 hasn’t appeared as a cause of death, even though Howard County has had 61 deaths due to the novel coronavirus.

According to Howard County Steve Seele, this isn’t because the information is being hidden for nefarious reasons, as has been alleged by some who have questioned him about the practice.

“People are not understanding why they aren’t seeing COVID listed as a cause of death. Right now, when all of this started, we were given directives from the Indiana State Department of Health guidelines," said Seele.

The guidelines suggest health departments black out this information for privacy reasons. Certain other diseases, such as AIDS or AIDS-related complex and HIV, are handled similarly when someone dies due to complications from these disorders.

But, said Seele, just because the public doesn’t see COVID-19 on public death certificates doesn’t mean it’s not on there and accessible to public health officials. It is listed on death certificates, just not the versions available to the public, according to the coroner.

“When news media prints or releases information from open records, there’s only a certain amount of information that is released,” said Seele. “I think people aren’t seeing COVID-19 listed as a cause of death, so there is an assumption being made that we are therefore making these numbers up or thus hiding those numbers. There’s just no truth to that. There’s no truth to that whatsoever.

“Howard County has striven very hard to make those numbers accurate, so our government can make proper decisions based on statistics … Also, the numbers are being reported in aggregate. Just because you don’t see the information on the person’s death certificate, there’s a lot more information on that death certificate that isn’t printed. People are making assumptions just because they don’t read the word ‘COVID-19’ on the cause of death. That printing doesn’t include everything.”

The Kokomo Perspective can confirm that some death certificates received by this office that appear to be from someone who died due to COVID-19 do have a line that is “whited out.” It appears this is the practice in play.

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Regardless, Seele said both his office and Howard County Board of Health work to ensure that reporting COVID-19 and related deaths is accurate by acting as a checkpoint for such information in a multi-step process.

That process begins with the physicians responsible for treating those with COVID-19. These physicians work to determine whether the novel coronavirus was a contributing factor to their patient’s death. Normally, said Seele, this is determined by reviewing the symptoms that were present in a patient prior to death, such as acute respiratory distress syndrome.

Current procedure mandates that the coroner’s office must be notified, and that’s noted on the death certificate the physician certifies.

From there, the coroner’s office and health department are notified, and the case is reviewed. Similarly, if the death certificate doesn’t indicate the coroner’s office was notified, funeral homes are required to notify the coroner’s office. Then a case can be further reviewed in case it slipped by, and it can’t receive final certification without approval from the coroner.

That process ensures government offices can review the cases and ensure their accuracy.

death certificate

CERTIFICATES — Above is an example of how a death certificate appears when it’s released to the public when COVID-19 presumably is whited out as a cause of death. Indiana code requires certain illnesses not to appear on public death certificates.

“As of right now, every COVID and COVID-related death crosses my desk,” said Seele. “It also crosses the desk of the health department … They are well aware of each and every death. Each and every death is reviewed. We have a good rapport with the physicians in our community. Sometimes when there is a question, whether it needs to be listed or not be listed as a contributing factor or non-contributing factor, obviously that conversation takes place between the physician, sometimes myself, sometimes the health department, as it has to be done.”

Also, Seele said he works to ensure that just because someone has died who tested positive for COVID-19, that doesn’t mean it’s always listed as the cause of death. Seele said patients must manifest symptoms of the virus, and it must have contributed to their death in order to be counted among state aggregate data.

Similarly, every COVID-19 death that is counted among the aggregate data reported to the state must actually have received a test, according to the coroner. There are times, he said, when a patient has been brought to a hospital for treatment and died prior to a test being administered or the test results received. But, Seele said tests must be run in cases where a patient dies without having received one, and in instances where patients die prior to test results being returned, the test results must have been received before the death can be certified as having been caused by COVID-19.

“I feel there are certain segments of death that should be a family matter, not a public matter … What people have to realize, still the statistics are being reported, but they are being reported as a total without attaching the person’s name to it,” said Seele.