Massachusetts COVID death count decreases by over 3,500 after updating criteria

BOSTON (March 10, 2022) – Beginning Monday, March 14, the Massachusetts Department of Public Health will update the criteria used for identifying COVID-19 deaths to align with guidance from the Council of State and Territorial Epidemiologists. Currently, the COVID death definition includes anyone who has COVID listed as a cause of death on their death certificate, and any individual who has had a COVID-19 diagnosis within 60 days but does not have COVID listed as a cause of death on their death certificate. The updated definition reduces this timeframe from 60 days to 30 days for individuals without a COVID diagnosis on their death certificate.

The revision follows the recommendation of the Council of State and Territorial Epidemiologists (CSTE), in collaboration with the US Centers for Disease Control and Prevention, to create a standardized approach for states to use for counting COVID-19 deaths. Several other states are adopting this definition.

Massachusetts has applied this new definition retroactively to the start of the pandemic in March 2020. As a result, 4,081 deaths in Massachusetts that were previously counted as associated with COVID will be removed. In addition, approximately 400 deaths not previously counted but identified through a manual process of matching death certificates with medical records will be added to the COVID-19 death count. The state’s overall COVID death count, therefore, will decline by 3,700.

“We are adopting the new definition because we support the need to standardize the way COVID-19-associated deaths are counted,” said DPH State Epidemiologist Dr. Catherine Brown. “Prior to the CSTE definition, states did not have a nationally recommended definition for COVID-19 deaths and, as such, have been using a variety of processes and definitions to count their deaths. In Massachusetts, our definition has consistently been broader than most other states. After a deep dive into our data and reviewing thousands of death certificates we recognize that this updated definition gives us a truer picture of mortality associated with COVID-19.”

“It is important to understand that we cannot identify all COVID-19 deaths with 100 percent accuracy,” said Nicolas Menzies, Associate Professor of Global Health at the Harvard T.H. Chan School of Public Health. “The revised definition for COVID-19 deaths is a reasonable balance between sensitivity and specificity and will make it easier to compare Massachusetts death data with data from other jurisdictions.”

“Updating this important metric is a necessary step to help us better gauge the current severity of the pandemic and its impact on our health system and society as a whole,” said Dr. Helen Boucher, Interim Dean of Tufts University School of Medicine, Chief Academic Officer at Tufts Medicine and infectious disease physician at Tufts Medical Center and member of the Governor’s Medical Advisory Board. “The ability to be nimble and quickly adapt to changing circumstances demonstrates Massachusetts’ continued leadership in COVID-19 data reporting and analysis.”

Early in the pandemic, and absent clear national guidance, DPH matched COVID-19 surveillance case information with death certificates to identify deaths in people who tested positive for the virus but did not have COVID listed as a cause of death. To avoid the possibility of missing any COVID-associated death, anyone who tested positive for COVID and died was counted as a COVID-associated death regardless of the length of time between their diagnosis and their death or whether COVID was listed as the cause on their death certificate. This approach was overly broad and led to an overcounting of COVID-19-associated deaths.

Beginning in April 2021, based on the growing knowledge about COVID-19 and an analysis of deaths in Massachusetts up to that point, DPH updated the way it counted deaths. COVID-19-associated deaths still included anyone with COVID-19 listed as a cause of death on the death certificate but DPH also applied a 60-day timeframe from diagnosis to death for anyone diagnosed with COVID-19 but who did not have COVID-19 on the death certificate.

This latest update further reduces the timeframe between diagnosis and death from 60 days to 30 days for individuals without COVID listed on the death certificate. The new definition will be reflected in the COVID-19 interactive dashboard data on Monday, March 14.

Beginning Monday, all calculations involving deaths posted in the COVID-19 dashboard and the raw data file will contain the updated data. Previous raw data files will still be available on the website and will not be updated.

Deaths in long-term care facilities will continue to be reported directly from those facilities, but the updated definition will align surveillance deaths more closely with the LTCF-reported counts.

Several new data points and some changes in functionality and visualizations are also being added to the COVID-19 dashboard, beginning Monday. No data are being eliminated and the changes are designed to enhance the interactive experience for dashboard users and to ensure compliance with Americans with Disabilities Act requirements.