The notion widely shared on social media that the federal Centers for Disease Control and Prevention reduced the U.S. COVID-19 death count by 94% — from nearly 154,000 down to just over 9,000 — is a misinterpretation of the data, a Denver metro epidemiologist explains.

Fact-checking reports from late August and early September focused on social media posts that used a misreading of a CDC data table to claim the agency had “admitted” its numbers were inaccurate. President Donald Trump was among those who tweeted the inaccuracy, which appeared to gain traction in late August.

“CDC just backpedaled (quietly) and adjusted the U.S. COVID deaths from 153,504 to 9,210. Admitting that their numbers are so (expletive) that they are off by a whopping 94%,” said a post that was shared on Facebook, the Associated Press reported.

The CDC data table in question — located on the agency's site — is based on an analysis of death certificates that mention COVID-19 as a cause. For 6% of the deaths, COVID-19 was the only cause mentioned, the CDC notes. The table showed 174,470 total COVID-19 deaths recorded as of its Sept. 9 update.

That regularly updated data table shows other health conditions that those who died of COVID-19 had, including Alzheimer's disease, diabetes and obesity, as well as problems that are caused by COVID-19 itself, such as respiratory failure and pneumonia, the AP reported. A death isn't excluded from the COVID-19 death count just because the person had other health conditions at the time.

'Well-established process'

The claim that COVID-19 deaths were over-reported “is an incorrect statement,” said Bernadette Albanese, a medical epidemiologist with the Tri-County Health Department.

The “CDC shares data on COVID-19 deaths for which the virus was the only identified cause of death (about 6% of all COVID-19 deaths) and deaths for which the virus infection was coupled with other underlying health problems that led to death (about 94% of all COVID-19 deaths),” Albanese wrote in a statement to Colorado Community Media. “Both are valid counts that add up to the totality of COVID-19 related deaths.”

The CDC runs through a “longstanding, well-established process” in gathering death data, said Albanese, whose department covers Adams, Arapahoe and Douglas counties.

“They do it for injuries, they do it for heart attacks, they do it for flu … and they do it now for COVID. They do it on behalf of states and every death in the United States,” Albanese said. She added: “There's nothing new about that process at all.”

The far majority of COVID-19 deaths occur among people 55 and older, who also often have other health conditions that make them more vulnerable to the severe impacts of COVID-19, such as pneumonia, Albanese noted. Public health officials have pointed to that trend for months.

“It is to be expected that those persons who die from COVID-19 also have other complicating health conditions contributing to death,” Albanese said.

Cause of death vs. other contributing conditions

For example, a person with an existing condition such as hypertension who dies due to COVID-19 would have COVID-19 listed as the underlying cause of death, according to the CDC's guidance for filling out death certificates. Hypertension would be listed in a separate section as a condition that contributed to, but did not directly cause, the death.

Death certificates are records that officials register for every death occurring in the United States, offering a complete picture of mortality nationwide, according to the CDC.

The CDC requires a physician, medical examiner or coroner to list a cause of death followed by other conditions that contributed to the death, according to Albanese.

The underlying cause of death is “the disease or injury which initiated the train of morbid events leading directly to death,” the CDC's guidance says.

“In many cases, it is likely that (COVID-19) will be the (underlying cause of death), as it can lead to various life-threatening conditions, such as pneumonia and acute respiratory distress syndrome,” the guidance says.

Probable vs. confirmed COVID-19 cases

The CDC's guidance adds: “Ideally, testing for COVID-19 should be conducted, but it is acceptable to report COVID-19 on a death certificate without this confirmation if the circumstances are compelling within a reasonable degree of certainty.”

The agency gives an example of an elderly person who ends up pulseless before emergency medical workers could respond — a situation where, although no COVID-19 testing was done, the coroner determines that the likely underlying cause of death was COVID-19 given the patient's high fever and severe cough and exposure to a family member who was diagnosed with COVID-19.

In cases where a definite diagnosis cannot be made, but it is suspected or likely, it is acceptable to report COVID-19 on a death certificate as “probable” or “presumed,” the guidance says, while noting that COVID-19 testing should be conducted whenever possible.

It was unclear from the CDC data table what portion of COVID-19 deaths listed were those for which COVID-19 was listed as a “probable” or “presumed” cause.

As of Sept. 9, Colorado had seen 1,979 deaths among people with COVID-19, and 350, or 17.7%, were listed as “probable,” according to the state's online data.

The state had tallied 1,889 people who died due to COVID-19, as opposed to the total who died with COVID-19 but not necessarily due to it.

However, the true death toll from the virus is widely believed to be higher than what the official numbers show, as experts say many victims died of COVID-19 without ever being tested for it, the AP has reported.

Update November 2021: See an explainer by The Economist on "excess deaths" and COVID-19 death estimates here.