CSTE Revised COVID-19-associated Death Classification Guidance for Public Health Surveillance Programs

Last Updated: Nov. 22, 2022

This guidance was developed by the Council of State and Territorial Epidemiologists (CSTE) with input from members and in collaboration with the Centers for Disease Control and Prevention (CDC). The guidance provides a revised consensus-based COVID-19-associated death classification, updating the prior document titled “Interim Guidance for Public Health Surveillance Programs for Classification of COVID-19-associated Deaths among COVID-19 Cases” (posted December 22, 2021). The prior classification included COVID-19-associated deaths identified through case investigation of confirmed and probable COVID-19 cases, deaths that occurred within 30 days of specimen collection of a laboratory test used to define the case (and the death was due to natural causes), and deaths identified only on vital records that lists COVID-19 or an equivalent term as an underlying or contributing cause of death without laboratory evidence.

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Throughout the pandemic, to provide timely information on COVID-19-associated deaths, STLTs developed surveillance systems to rapidly generate mortality data including case investigation data, mortality reporting systems, and through matching SARS-CoV-2 infection electronic laboratory reporting case surveillance with temporally associated death data from vital statistics. These data have often been generated, posted publicly, and reported to CDC prior to the availability and posting of CDC National Center for Health Statistics’ (NCHS) National Vital Statistics System (NVSS) official data.