A nurse attaches a
The pandemic did not lead to changes in how US death certificates are filled out. Image by AP PHOTO

Death certificate change claim is dead wrong

David Williams May 3, 2024

US authorities changed the process for death certificate reporting exclusively for COVID.


False. The process for death certification has remained largely unchanged since 1939.

US authorities modified death certificate reporting exclusively for COVID-19, thus inflating the number of fatalities during the pandemic,  a naturopath claims.

This is false. Medical experts and the US Centers for Disease Control (CDC), the agency in charge of reporting protocols, told AAP FactCheck death certificate reporting has remained unchanged for more than 80 years.

The claim was made in a video shared to an Instagram account. A longer version has been shared on X.

It features an interview with US naturopath Henry Ealy, founder of the Energetic Health Institute, claiming the CDC modified death certificate reporting during the pandemic.

A screenshot from the Instagram post.
 Medical experts say the video’s claims are false. 

This is the certificate Ealy is referring to, with instructions for completing the cause-of-death section by a medical examiner or coroner.

Cause of death is split into two parts. Part I is for the immediate cause, and there are lines for conditions that immediately contributed to the death, in sequential order from most significant to underlying causes.

Part II is for other comorbidities – significant conditions that contributed to death but not resulting in the underlying cause given in Part I.

“The first thing they did was they modified death certificate reporting exclusively for COVID,” Ealy says in the video.

“They said, ‘If you have a comorbidity, normally we would put that in Part I, which is cause of death’.”

“The thing is though, what’s always been charted as the cause of death is the oldest line item. So if you had, let’s say, asthma or COPD … chronic obstructive pulmonary disease, let’s say it was for 10 years, well if you contracted COVID and died, COVID wouldn’t be the cause, COPD would be the cause because it was the oldest-known disease process.

“What the CDC said through the national vital statistics system is, ‘we don’t want you to put comorbidities in Part I, just put them in Part II, which are contributory factors to death’.”

He further claims “96 per cent of all death certificates for COVID had on average 4.0 comorbidities” and the CDC removed “the actual cause which is the comorbidity and you’re saying ‘no, it’s going to be COVID no matter what’.”

Hospital staff caring for COVID-19 patients (file image)
 A naturopath claims US COVID deaths were exaggerated. 

Ealy is also lead author of an October 2020 paper, published by Science, Public Health Policy and The Law, which makes the same claim.

The paper’s claim was fact-checked at the time. The check compared the CDC’s guidelines on certifying deaths from 2003 and 2020, finding the comparison “doesn’t reveal any significant change in procedure”.

Brian Moyer, director of the US National Center for Health Statistics, which is part of the CDC, told AAP FactCheck the claim was “absolutely false”.

He said Part I was for the sequence of diseases and conditions leading to death and had been largely unchanged since 1939 (a fourth line was added to Part I in 1989). 

“The idea that the oldest-known disease is the cause that should be reported in Part I is false and not supported by the instructions,” Dr Moyer said.  

“Suppose that a decedent had cancer for 10 years and then was in a car accident and died. It would be absurd in this case to assert that cancer, as the oldest disease process, would be the cause of death. The car accident would be appropriately reported in Part 1 as the underlying cause of death.

“It is also false that COVID-19 can’t be the cause of death if other comorbidities were previously present.”

A medical doctor (file image)
 Medical examiners say death certificate processes haven’t changed. 

Dr Moyer said the focus of Part I was the direct causal sequence, not the oldest-known disease.

“If the cause of death certifier determines that COVID-19 initiated that chain of events leading to death, it should be reported as the underlying cause in Part I, even if multiple comorbidities were also present,” he said.

James Gill, chief medical examiner for the State of Connecticut and a clinical professor of pathology at Yale School of Medicine, also told AAP FactCheck there was no change in how the cause of death was recorded.

“COVID deaths were certified the same as deaths due to influenza. Part II is for other significant or contributory conditions,” Dr Gill said

J Keith Pinckard, president of the National Association of Medical Examiners, also said Part I was always reserved for the chain of events that led to death. 

“A comorbidity that is believed to have contributed to the death, but did not directly lead to the cause of death, is appropriately listed in Part II,” Dr Pinckard told AAP FactCheck.

“In my experience, forensic pathologists do not give precedence to the oldest-known disease process, but rather to the condition believed to have actually caused the death.”

The Verdict

The claim US authorities changed the process for death certificate reporting exclusively for COVID is false.

A comparison of the CDC’s guidelines shows the guidance was the same in 2003 as it was for 2020. Medical experts told AAP FactCheck the process was not changed. The CDC says the process has remained largely unchanged since 1939.

False — The claim is inaccurate.

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