National Center for Health Statistics

Near-real time surveillance of COVID-19 mortality using 

data from the National Vital Statistics System

Paul D. Sutton, Ph.D. and Lauren M. Rossen, Ph.D. 

National Center for Health Statistics

2020 FCSM Fall Conference 

September 21, 2020

1
National Vital Statistics System (NVSS)

The NVSS is the mechanism by which NCHS collects and disseminates the Nation’s official vital statistics 

on births, deaths and fetal deaths. These data are provided through contracts between NCHS and the 

57 vital registration jurisdictions (50 States, the District of Columbia, New York City and 5 territories). 

Final Data 

▪ Annual Final Micro-data files 

▪ Analytic Reports 

Provisional Data 

▪ Tabulated counts and estimate based on incomplete data 

– Quarterly Provisional Estimates 

– Weekly Surveillance of Flu and Pneumonia Deaths 

– Monthly Provisional Counts of Drug Overdose Deaths

2
Provisional COVID-19 Death Counts: Understanding the 

Numbers

Things to know about the data 

▪ Provisional counts are not final and are subject to change 

▪ Provisional data are not yet complete 

▪ Death counts should not be compared across jurisdictions 

Why these numbers are different 

▪ Death certificates take time to be completed 

▪ States report at different rates 

▪ It takes extra time to code COVID-19 deaths 

▪ Other reporting systems use different definitions or methods for counting deaths 

https://www.cdc.gov/nchs/data/nvss/coronavirus/Understanding-COVID-19-Provisional-DeathCounts.pdf

3
Guidance for Certifying COVID-19 Deaths

https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf

4
Guidance for Certifying COVID-19 Deaths: Key Points

▪ If COVID–19 played a role in the death it should be mentioned on the death certificate 

▪ It is acceptable to report COVID–19 on a death certificate as “probable” or “presumed” – certifiers 

should use their best clinical judgement in determining if a COVID–19 infection was likely and if the 

infection contributed to death 

▪ Include pre-existing conditions that complicated death in Part 2 of the death certificate

5
COVID-19 Cause of Death Coding: ICD-10 Code

U07.1 -- COVID-19 

Excludes: Coronavirus infection, unspecified site (B34.2) Severe acute respiratory syndrome [SARS], 

unspecified (U04.9) 

The WHO has provided a second code, U07.2, for clinical or epidemiological diagnosis of COVID-19 where

a laboratory confirmation is inconclusive or not available. Because laboratory test results are not typically 

reported on death certificates in the U.S., NCHS is not planning to implement U07.2 for mortality 

statistics. 

The underlying cause depends upon what and where conditions are reported on the death certificate. 

However, the rules for coding and selection of the underlying cause of death are expected to result in 

COVID-19 being the underlying cause more often than not. 

6
COVID-19 Cause of Death Coding: Coding Process

▪ Coding systems not set up to code COVID-19 or to accept U07.1 

▪ Establish coding rules 

▪ Initially all COVID-19 records had to be manually coded 

▪ Managing manual coding 

– Prioritization 

– Increase manual coding capacity 

▪ Systems modified to automatically code some COVID-19 deaths 

▪ Adjust coding rules

7
Provisional COVID-19 Death Counts by week

Data as of September 8, 2020

Week ending 

date in which 

the death 

occurred

COVID-19 

Deaths (U07.1)

Deaths from All 

Causes

Week ending 

date in which 

the death 

occurred

COVID-19 

Deaths (U07.1)

Deaths from 

All Causes

Total 174,626 1,881,375 5/23/2020 7,136 61,266

2/1/2020 0 58,568 5/30/2020 6,090 59,283

2/8/2020 1 59,282 6/6/2020 4,961 58,406

2/15/2020 0 58,688 6/13/2020 4,163 57,481

2/22/2020 5 58,723 6/20/2020 3,771 57,301

2/29/2020 9 59,149 6/27/2020 3,728 57,683

3/7/2020 35 59,507 7/4/2020 4,383 58,557

3/14/2020 52 58,303 7/11/2020 5,518 59,842

3/21/2020 571 58,966 7/18/2020 6,820 60,431

3/28/2020 3,151 62,853 7/25/2020 7,676 60,670

4/4/2020 10,007 72,108 8/1/2020 7,393 59,372

4/11/2020 16,160 78,837 8/8/2020 6,799 57,887

4/18/2020 17,039 76,505 8/15/2020 5,535 54,280

4/25/2020 15,401 73,569 8/22/2020 3,504 46,411

5/2/2020 13,114 68,960 8/29/2020 1,192 30,152

5/9/2020 11,141 66,521 9/5/2020 128 7,652

5/16/2020 9,143 64,162 8