A death certificate is a final marker in someone's life — an official accounting of the end.
The legal forms are used by families to settle estates and by public health officials to assess whether the healthcare system is addressing the actual reasons for our demise.
Despite their importance, study after study has shown that as many as half of them are wrong.
Faced with SARS-CoV-2, a highly contagious coronavirus that scientists had never seen before, federal officials at the Centers for Disease Control and Prevention issued guidance this spring aimed at improving the accuracy of what doctors identify as the cause of death.
On death certificates, doctors have often blamed heart disease and other chronic conditions for deaths actually caused by viruses, lethal bacteria and other infections — leading health officials to underestimate their role in American mortality.
The CDC's guidance, in essence, reminded doctors to ask a basic question: Why did the patient die when they did? If the doctor believed COVID-19 had cut the patient's life short, the disease should be written on the death certificate as the underlying cause of death, the rules said.
"If you know why people die, very often then you can develop programs to prevent people from dying from those causes," explained Robert Anderson, chief of the mortality statistics branch at the CDC's National Center for Health Statistics, which issued the guidance in April.
The April guidelines were needed, officials say, to trace the coronavirus and understand how to stop its spread. But the move has been attacked by critics who believe it has inflated the death toll of the coronavirus by wrongly blaming COVID-19 for unrelated fatalities.
Infectious disease experts say the new guidance is crucial to understand why overall U.S. deaths surged in April to more than 40% above what would otherwise be expected that time of year and even now remain elevated by about 10%.
Scientists are trying to determine how many of those "excess deaths" were caused by the virus and how many were from indirect consequences of the pandemic and stay-at-home orders. Recent studies have shown, for example, that some people delayed needed emergency medical care as officials ordered hospitals to be cleared to focus on virus victims.