WHO LIVES, WHO DIES, WHO TELLS YOUR STORY — More than a year and a half after the U.S. recorded its first Covid death in February 2020, there is still no consensus about the exact number of people who have been killed by the disease. The official tally is more than 725,000, according to the CDC, a number the U.S. hit Monday, the same day that Colin Powell died from Covid complications.

But did Powell’s passing count as a death from Covid? Surprisingly, there is no consensus on that question. “There is no standardized national case definition that I am aware of yet,” Michael Phillips, chief hospital epidemiologist at NYU Langone Health, told Nightly today. “There are a lot of opportunities for difference.”

The phrase “died of Covid complications” meansa variety of different things with no definition. States — or even individual hospitals — have their own criteria for how to count deaths from Covid.

Death investigations in the U.S. are generally “non-uniform,” James Gill, the current president of the National Association of Medical Examiners, said. There are more than 2,000 jurisdictions that report deaths in the U.S.: Coroners, physicians, sheriffs, justices of the peace and others can all fill out death certificates. Those death certificates are what the CDC examines for its official tally.

States’ official tallies are climbing as jurisdictions revise their death tolls based on a closer look at death certificates. Oklahoma added more than 1,000 deaths to its count this week after the state health department investigated Covid deaths. New York added nearly 12,000 Covid deaths to its official tally in August after accounting for all death certificate data and not just those from hospitals, adult care facilities and nursing homes. Both states’ data now more closely match the CDC numbers.

At NYU, every patient who comes into the hospital — regardless of why they are there — gets tested for Covid to trigger infection protocols if necessary, Phillips said. If the patient is still in the infectious period when they die, NYU counts that as a Covid death.

For the most part, NYU’s Covid death count accurately captures the number of people who died because they contracted Covid, Phillips said. But there are rare cases in which a gunshot victim who tests positive gets thrown into the official count.

It’s far likelier that there is an undercount of Covid deaths, rather than an overcount. People who don’t die in hospitals, say in nursing homes or prisons or in their homes, may never have been tested before dying.

The CDC counts only deaths where Covid is listed on a death certificate as a cause or contribution to the patient’s passing. It acknowledges that about 20 to 30 percent of death certificates have issues with “completeness,” saying “cause-of-death information is not perfect, but it is very useful.”

These subtleties will be important to historians who study the pandemic and its toll. But they don’t matter for most Covid patients. It’s clear what they died of, Lisa Maragakis, an infection prevention specialist and epidemiologist at Johns Hopkins Health System, told Nightly. The distinction between dying of Covid and dying from complication of Covid isn’t part of the official language.

Often a person comes into the hospital because of Covid, but that can lead to a series of other related problems, such as sepsis or organ failure. A family might withdraw care after a patient has been unresponsive on a ventilator for a long time. Or a patient could die from severe lung damage. A death certificate might list the official cause of death as pneumonia, heart attack or stroke, but if Covid is what brought that ailment on, it’s listed as a contributing factor. Overwhelmingly, she said, respiratory failure is what is killing the Covid patients she sees.

People with compromised immune systems or an underlying health conditions are prone to dying if they get Covid, but Covid is still the reason that patients like Powell died, said Maragakis. Their weakened immune systems couldn’t fight off the infection, but had they never gotten Covid, they would still be alive.

“People live with cancer for a long time,” she said. “It is pretty clinically clear that Covid was the thing that tipped them over.”

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