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Cause of death is the final chapter in everyone’s complicated story

Every life is a complicated story. 

Every death is, too. And a person’s death certificate is how we tell the final chapter. 

Underlying conditions vs. cause of death.

Underlying health conditions play an important role in many people’s stories:

  • Did they survive cancer? 
  • Were they a smoker? 
  • Did they live with diabetes? 

Factors like those play an important role in your health, and often offer clues to how that final chapter could unfold. But a death certificate is the story of only the final pages.

A person who dies of a heart attack, for example, might have been overweight and a smoker. But the heart attack was the final cause of death. Or, perhaps a cancer survivor has a compromised immune system and dies from the flu. The flu is the cause of death.  

This same process holds true for COVID-19 deaths. Though most people who die from it have underlying conditions, COVID-19 was the final chapter.

A woman holding a death certificate

A detailed process provides important answers.

We’ve heard your questions about the accuracy of COVID-19 death reporting. It helps to understand the process of producing a death certificate. 

When somebody dies:

  • A funeral director, healthcare provider or medical examiner starts the death certificate.
  • They enter the data into our state’s Electronic Death Registration System.
  • That information is sent to the primary healthcare provider who cared for the person.
  • The healthcare provider assigns a cause of death.
    • They usually know the person’s history and why they died.
    • If the person died at home and the cause is unknown, the medical examiner may conduct an autopsy and determine the cause of death.
  • The certificate is sent to the Health Department. We review it to ensure the cause makes sense.
  • Quality control checks are in place throughout the process. 

During a unique event like COVID-19 where we are providing death information in almost real time, we may adjust information during quality checks. We’ve let you know when we are changing case counts or death information because we find out a case belongs to another county or was already reported. We also review preliminary information about cause of death. Department of Health recently updated COVID-19 death counts to remove deaths in people who had a positive COVID-19 test but may have died of other causes. We also updated our death information today to set aside four deaths that we need to further assess to determine if COVID-19 was the cause of death, or if they should be removed from Pierce County’s total COVID-19 deaths.

Healthcare providers who determine cause of death take their jobs very seriously. In the U.S., physicians follow the Centers for Disease Control and Prevention’s rules to identify cause of death. They use their best medical judgement to name the immediate cause and underlying causes. 

COVID-19 ends many stories.

Deaths related to COVID-19 follow this same process. That’s why we know most of the people who died from COVID-19 suffered underlying conditions. 

In many cases, those people might have lived years longer had they not been infected. So, although underlying conditions left them more susceptible to the virus’ effects, we know they died sooner because of COVID-19.

Death certificates and COVID deaths are complex. Next week I will write about the potential for under reporting, under testing and how other factors could both inflate and decrease the number of Pierce County’s COVID deaths.

For more information about COVID-19, visit