Just how many Americans have died as a result of Covid-19? It turns out, unfortunately, it depends on whom you ask. As the death toll started to increase over the summer months in the United States, a false narrative that many or even most of the deaths associated with Covid-19 were exaggerated has started to emerge. This seems to be in large part due to a report from the Centers for Disease Control and Prevention (CDC) which stated that “For 6% of the deaths, COVID-19 was the only cause mentioned.”

Indeed, this 6 percent stat has become a rallying cry of sorts for conspiracy theorists and far-right defenders of President Donald Trump. This is especially true in the conservative echo chambers of social media. The point of these posts is to cast doubt on the public health, medical and scientific communities, claiming they are purposefully overstating the impact of the coronavirus in the U.S., probably to hurt Trump.

The truth is that in 6 percent of the deaths, Covid-19 was the only cause of death listed and in the remaining 94 percent, people had at least one additional factor contributing to their deaths. Stated another way, the majority of Americans who died from Covid-19 had another medical condition on top of the coronavirus at the time of their death. Many patients died in the hospital, often intubated, on mechanical ventilation and with multiple organ failure due to the invasive nature of the virus; the red spikes on the surface of the virus wreaking havoc by tearing into the body at a cellular level. And deaths were certainly not limited to the elderly, another falsehood that has been touted as a reason to reopen businesses and schools without caution. Children and young adults are also dying from Covid-19, with serious infections increasingly affecting young adults.

Sept. 24, 202002:30

This is not at all surprising given what we know about the virus, nor does it mean that we’re overcounting fatalities attributed to it. Perpetuating the false notion that the virus is not serious or is only lethal to a select population (the elderly) is part of why we just reached 1 million deaths globally and still seeing approximately 1,000 deaths a day in the U.S. Simply put, misinformation is enhancing the virus’s lethality.

While ascertaining whether an individual is dead or alive is relatively straightforward — checking pupils for response to light, response to touch, spontaneous breaths and the presence of heart sounds — the accurate documentation of the cause of death has grown in importance over the last decades. Tracking cause of death first emerged in 1839 in the records of Dr. William Farr, a British physician often thought of as the father of medical statistics. Today, advances in medical technology allow people to live decades with multiple, once-deadly diseases. This means increasing numbers of Americans are able to live long lives with pre-existing conditions. It also means determining the cause of death can be more complicated.

To be clear, the public health community is very purposeful about how and why someone died right now. A medical professional is required to assess immediate and underlying causes of death on a death certificate. Given the importance of identifying deaths from Covid-19 accurately, the World Health Organization (WHO) has issued clear, detailed guidance. This is important for a number of reasons: first, resources such as personnel, ventilators and other equipment can be mobilized more effectively when we understand the impact of the virus at a local level. Second, accuracy is important in understanding the effect of interventions on patients at risk of dying — what we understand today about treatments such as remdesivir and dexamethasone is tied to highly documented clinical trials in hospitals. Finally, the numbers are critical for global policymakers who must decide when should we impose restrictions in towns and cities, what is the desired effectiveness of a worldwide vaccine, and what is the impact of the virus on our nation’s economy.

Despite all of the care involved, we know gaps in our data exist — just not the kinds of gaps conspiracists claim. For example, researchers estimate that official death counts are likely an underestimate — this is in part due to the limited availability of viral testing, particularly early in the pandemic, as well as the variable performance of the Covid-19 tests. Importantly, the tests skew negative, not positive. We also know that there are delays in reporting, due to variability in how states collect and report data.

Despite all of the care involved, we know gaps in our data exist — just not the kinds of gaps conspiracists claim.

What is clear is that the current death toll of over 206,000 people in the United States is indeed real and will likely increase to somewhere between 300,000 and 400,000 deaths by the end of the year. Furthermore, analyses by the CDC and the National Center for Health Statistics (NCHS) have shown that total death numbers have likely exceeded even the official death counts by 20-30 percent; the total death number takes into account deaths outside of hospitals and health care facilities, often in homes or other institutions for which there might not be a medical professional assessing the cause of death. In other words, we are seeing more deaths than normal, and the main factor that is different now is the virus.

But while it’s vital that public health officials know exactly who is dying, it’s also important that the public understand the reality of this pandemic. Misinformation can have serious consequences. Unfortunately, despite the removal of damaging Facebook posts and tweets, a growing number of people question the necessity of wearing masks, maintaining social distancing measures, and restricting businesses and schools. Viral posts claiming “only 9,000” Americans have really died from Covid-19 only fuel this vocal minority — especially when promoted by the president himself.

The irony is that the insertion of doubt into the most fundamental way we count deaths has likely contributed to our growing number of infections. As the country braces for a winter season that could bring more fatalities, it is important to be clear in communication: Covid-19 is quickly becoming a top cause of death across the world.

Global deaths from Covid-19 now exceed the combined total numbers of people who have died from the flu, malaria, cholera and measles. Practicing public health strategies responsibly, including using facial coverings, physical distancing and handwashing could save your life or the life of someone around you. Sharing posts with dubious scientific claims will do the opposite.

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