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How medical examiner determines COVID-19 as primary cause of death

Gov. Gary Herbert addresses reporters via video conference on Thursday, Sept. 3, 2020. The state medical examiner addressed how COVID-19 deaths are determined. Screen grab from

SALT LAKE CITY — Are coronavirus death numbers in Utah being overinflated or underreported — or are they accurate? The state medical examiner explained how health departments determine COVID-19 as the cause of death during a news conference Thursday.

“We have this rumor out there that somehow people are dying, but we label it COVID-19 when it’s  something else that they’re dying from,” said Gov. Gary Herbert during the Thursday weekly update. “So we’re mislabeling them for whatever reason, like there’s a conspiracy going on.”

Dr. Erik Christensen, chief medical examiner at the Utah Department of Health, also disputed this — addressing how the state Medical Examiner’s Office (OME) pinpoints COVID-19 as the main cause of death.

This comes as Utah reported four additional COVID-19 deaths Thursday, bringing the state’s total to 414 since the pandemic began.

The U.S. reports more than 6 million cases of coronavirus and about 186,000 deaths attributed to COVID-19 as of Thursday.

Determining COVID-19 as cause of death

The OME is tasked with investigating and reporting all deaths resulting from diseases deemed a threat to public health.

“There has been much discussion about what constitutes a death from COVID-19,” Christensen said. “With so many individuals having advanced stages, as well as comorbid conditions, how can we be sure that people are not just dead from these other illnesses and processes that were already going on in their bodies?”

Christensen said underlying conditions shown to contribute to COVID-19 deaths include respiratory failure, acute lung injury, sepsis, abhorrent inflammatory responses, blood clots and a variety of others.

Potential risk factors involved in coronavirus deaths include diabetes, hypertension and obesity, among others, he said.

When a death is reported, OME investigators take a history of events from reporting parties, including a review of circumstances and events that led up to the death. This includes medical history and issues, exposure to COVID-19, a list of positive test results and the date the tests were given.

After the original report, the OME requests records from hospitals, long-term care facilities, hospice organizations and occasionally law enforcement.

Sometimes a follow-up investigation is done with family members and certifying physicians to gain clarity on what occurred during the person’s final days and hours.

Most of the deaths investigated by the OME are reported to the state health department, which are then reported publicly.

Confident in state numbers

Christensen said almost all cases of death originally investigated as caused by COVID-19 end with the same determination.

“Rarely does the information that we receive outfront turn out not to be the case,” he said. “Which is also true for deaths not related to COVID-19.

A death certificate is changed whenever a death, originally reported as the result of COVID-19, is determined not to be primarily caused by coronavirus, Christensen said.

The health department detects false COVID-19 deaths in about 1% of cases, according to Christensen.

Deaths from trauma and drug intoxication are not reported as COVID-19 deaths, but if the decedent tests positive for coronavirus, it is reported as such, he said.

“All deaths reported in Utah to date have been based on positive test results as well as a history consistent with COVID,” Christensen said.

“The robust system of checks that we have in place to identify the deaths, the investigative review process that we have to ensure that what is reported is consistent with that certification as well as the normal processes of the OME to ensure that deaths from COVID-19 that occur outside the medical-care system are also found and identified,” Christensen said.

All deaths in Utah reported to the OME are thoroughly reviewed in-depth to ascertain whether COVID-19 is part of the cause of death.

Christensen said he is confident in the state’s coronavirus numbers being reported.