COVID-19 is reportable by law, under Rule R386-702 Communicable Disease Rule, to the Utah Department of Health.
The UDOH uses the CDC Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID-19) to determine which deaths are due to COVID-19. This guidance is sent by the Utah Department of Health Office of Vital Records and Statistics to every medical certifier in the state, the Utah Hospital Association, and Utah Medical Association.
Process for recording deaths in Utah
When someone is tested for COVID-19, the lab processing the sample submits the test results to the Utah Department of Health via a database called EpiTrax. Data sharing agreements are in place to allow the Utah Department of Health Office of Vital Records and Statistics to share a list of Utah deaths with COVID-19 or any derivative listed on the death certificate to EpiTrax on a daily basis. EpiTrax also shares a daily list of deceased individuals who test positive for COVID-19 with the Office of the Medical Examiner.
The following flow chart shows how a death record is processed in Utah.
Determining Cause of Death
Cause of death is a narrative field on the death certificate. A certifier lists, in sequence, any health conditions a decedent had (a health history) and the cause of death. They may also list any suspect COVID-19 symptoms which would then be reviewed and investigated further by Vital Records or the Office of the Medical Examiner. The information is reviewed by Vital Records offices at the local level and if needed, further investigation into the cause of death can be done. After a local investigation is complete, the local Vital Records office registers the death and the information is sent to the UDOH Office of Vital Records and Statistics. The Utah Department of Health sends the information to the Centers for Disease Control and Prevention where ICD10 codes are applied. Any codes listed as R00-R99 are sent back to Utah Department of Health for further investigation and clarity. This is the same process used for any death in Utah.
EpiTrax, Vital Records offices at the state and local level, and the Office of the Medical Examiner provide checks and balances throughout the process of certifying and registering deaths. This allows any of the checkpoints to investigate deaths due to COVID-19 and share information. The Office of the Medical Examiner has the final determination of the cause of death. Each system investigates the death. Daily lists of COVID-19 cases are sent to the Office of the Medical Examiner from the Utah Department of Health epidemiology team for review and to ensure all COVID-19 deaths in Utah are captured.
Because this is a novel disease, the Office of the Medical Examiner has made the decision to take jurisdiction over all COVID-19 deaths in Utah (authority for this is given per the Utah Medical Examiner Act). This allows the Office of the Medical Examiner to review all COVID-19 related deaths and track them in EDEN.
Do all deaths go through the Office of the Medical Examiner?
Only about 15-18% of ALL deaths in Utah go to the Office of the Medical Examiner. All decedents who go to the Office of the Medical Examiner are tested for COVID-19, regardless of the cause of death. For example, if someone dies in a car crash and their body is sent to the Office of the Medical Examiner, a COVID-19 test is done. If the test result is positive but the cause of death was a car crash, they would NOT be counted in the COVID-19 deaths (it would be listed as a motor vehicle crash on the death certificate). They would, however, be counted in our positive COVID-19 cases counts.
Individuals without prior medical care or testing for COVID-19 but with a history of symptoms suggestive of COVID-19 are also brought to the Office of the Medical Examiner for testing, examination, and investigation into the circumstances surrounding their death.
What if the body doesn’t go to the Office of the Medical Examiner?
If an individual tests positive for COVID-19 and then dies, EpiTrax and Vital Records link the patient as a COVID-19 death, even if the death certificate doesn’t list COVID-19. COVID-19 deaths are only ruled out if the Office of the Medical Examiner determines the death was not caused by COVID-19 upon further investigation.
It is likely the number of COVID-19 cases (not deaths) in Utah is higher than what the case counts show. However, given the robust reporting systems and checks-and-balances with EpiTrax, Vital Records, and a centralized medical examiner system, the Utah Department of Heath believes the number of deaths due to COVID-19 not captured in our data is very small.
For data privacy reasons, the Utah Department of Health is unable to provide the date-of-death for each death each day. The COVID-19 data dashboard includes a chart that shows the actual date-of-death (bottom left of the “Hospitalizations and Mortality” tab).