PIERRE, S.D. (KELO) — A state representative and nursing home patient both died last week after being diagnosed with COVID-19. KELOLAND News reported both deaths on Friday, but it wasn’t until late Monday morning when the state officially reported those deaths.

That’s because the South Dakota Department of Health is not reporting fatalities until a certified death record has been filed, which can take up to five days after the person has died.

South Dakota State Epidemiologist Dr. Joshua Clayton said it’s to help paint a more accurate picture.

“The information is just a brief time delay for individuals that are reported to our website, but that is to help ensure that the information that we’re reporting to you is correct and is based on the information that is available to the clinician,” Clayton said.

Federal government says a test isn’t needed for death certificate ‘if the circumstances are compelling within a reasonable degree of certainty’

Getting data on deaths is key to tracking the COVID-19 pandemic, according to new guidance from the Centers for Disease Control and Prevention.

“In public health emergencies, mortality surveillance provides crucial information about population-level disease progression, as well as guides the development of public health interventions and assessment of their impact,” the agency said in a new document.

The National Vital Statistics System, a division of the CDC, released the new guidance on death certificate reporting last week. The guidance offers information on how to report COVID-19 on a death certificate, but also underscores the importance of the data.

“Monitoring and analysis of mortality data allow dissemination of critical information to the public and key stakeholders,” the document said.

It also makes clear a COVID-19 test isn’t required to mark it as the cause of death.

“Ideally, testing for COVID–19 should be conducted, but it is acceptable to report COVID–19 on a death certificate without this confirmation if the circumstances are compelling within a reasonable degree of certainty,” the document said.

What the guidance doesn’t do is require states to report publicly in a certain time period. That’s a state-by-state decision.

“Once we do have the death certified, we do report that information,” Clayton said.

The state’s Secretary of Health, Kim Malsam-Rysdon, emphasized that physicians or the medical examiner are required by law to file the death certificate within a five-day window.

“That just has to be part of the process as well,” she said.

A patchwork of reporting methods

South Dakota isn’t the only state following this process of reporting deaths. KELOLAND News reached out to several state departments of health across the country to see how they handle the process and worked with our newsgathering partners across Nexstar Media Group.

New York

Medical workers wearing personal protective equipment intake bodies through a tent before loading them onto a refrigerated trailer serving as a makeshift morgue at Wyckoff Heights Medical Center, Monday, April 6, 2020, in the Brooklyn borough of New York. The new coronavirus causes mild or moderate symptoms for most people, but for some, especially older adults and people with existing health problems, it can cause more severe illness or death. (AP Photo/John Minchillo)

In New York, the state reports directly from the hospitals, nursing homes and health care facilities on a daily basis. It also reports sex, county, age group and other health conditions the patients were suffering from.

The agency does warn the information is preliminary and subject to change as more investigations happen.


Another hotspot is California, and that state doesn’t wait for death certificates, the California Department of Public Health told KELOLAND News.

The amount of time varies depending on a variety of circumstances including where the death happens, whether testing was done before death, and how the death was reported. For example, a report of a death that happens in a hospitalized person known to have COVID-19 could happen within a few days because the diagnosis was already known and the local health department was likely already aware of the case. Another example, a death that happens in the community with no prior testing could take time for COVID-19 to be considered as a cause of death, for specimens to be collected, for test results to come back, and for the case to be reported to the local health department. Once a report is made of a COVID-related death to CDPH, CDPH reports the death in the death count within one day.

The California Department of Public Health


In Iowa, a similar process is followed, a spokesperson with the Iowa Department of Public Health told KELOLAND News.

“We are in regular contact with county public health departments who are investigating cases and the health care facilities that care for patients,” said Amy McCoy. “Those partners alert us if a patient with a known positive test and a death occurs, and we report that information in daily reports to Iowans.”

She also said if they do a test after someone has died, it may take several days to confirm.

“That information is also shared once it is confirmed,” McCoy said. “We also coordinate with our Office of Vital Statistics to review reports.  The state only reports cases that have had positive tests.”

Iowa Gov. Kim Reynolds holds a news conference regarding COVID-19 at the State Emergency Operations Center in Johnston, Iowa, Monday, April 6, 2020. (Oliva Sun/The Des Moines Register via AP, Pool)


A CBS affiliated station in Louisiana reports the state has now told coroners they don’t need to wait for a death certificate before they mark a COVID-related death, to get more up-to-date information.

A temporary hospital has been set up in the Ernest N. Morial Convention Center, as overflow for local hospitals that are reaching capacity, in response to the COVID-19 pandemic, in New Orleans, Saturday, April 4, 2020. Phase one of the operation can house 1,000 patients with the capability to double that capacity as needed. The facility will open April 6. (AP Photo/Gerald Herbert)


Indiana appears to follow the same process as South Dakota, waiting until death certificates are issued before confirming a death.


Soldiers take part in a ventilator training session at the site of a military field hospital, Sunday, April 5, 2020, at the CenturyLink Field Event Center in Seattle. Officials said the facility, which will be used for people with medical issues that are not related to the coronavirus outbreak, has more than 200 beds and is ready to receive patients. (AP Photo/Ted S. Warren)

In Washington state, where the first outbreak occurred in the U.S., the state department of health said sometimes data is released by health care providers or local health departments before they’re included in the statewide count.

“It takes longer for the state to announce deaths because they are often reported first to the local health department and then to us,” the department said on its website.


In Illinois, the Department of Public Health said it reports the deaths with lab-confirmed cases of COVID-19.

“Deaths are reported via an electronic system to public health by coroners, hospitals, and local health departments, and through vital records,” an IDPH spokesperson said in a statement. “IDPH then checks for the laboratory confirmed results.  Coroners do not handle every death.”

A public service message is seen on a billboard near the Dan Ryan Expressway Monday, March 30, 2020, in Chicago. The new coronavirus causes mild or moderate symptoms for most people, but for some, especially older adults and people with existing health problems, it can cause more severe illness or death. (AP Photo/Charles Rex Arbogast)


Alabama has two counts: the first is reported deaths and the second is died from illness.

“To count a person who died from COVID-19 disease, the medical record of the deceased person has to be reviewed by a physician and Infectious Disease and Outbreak staff,” the Alabama Department of Public Health said on its website. “Once review is complete, if the death is attributed to COVID-19, the individual will also appear in the Died From Illness on the dashboard.”


KELOLAND News reached out to a number of health departments that didn’t yet respond. One of those is Minnesota, where it appears the official count is sometimes ahead of the death certificates being reported to the state. Minnesota Public Radio reported last week on Thursday, the state office that handles death certification only received 10 of the 18 in the official state count at the time.

The Mary Tyler Moore statue on Nicollet Mall got a mask and rubber glove, perhaps for levity in the face of the Coronavirus, and seen Wednesday, April 1, 2020, in downtown Minneapolis. (David Joles/Star Tribune via AP)

This patchwork of the different ways of reporting the deaths has led public health experts to believe the number of deaths in the United States is higher than currently being reported.

As of 5 p.m. on Monday, the death toll in the United States was:

Johns Hopkins is the most-up-to-date, pulling from state and national government health departments and local media reports. The National Vital Statistics System is only updated weekly, and there is a warning in the document about significant lag time in reporting.

South Dakota not using the number of deaths in modeling

In South Dakota, Clayton said the death count isn’t being used in the modeling by the state.

“We’re not focused on deaths in terms of the modeling that we have been doing,” Clayton said. “We are focused on cases and hospitalizations to help inform that model.”

The state released data on the model on Friday, projecting that between 30 and 70 percent of South Dakotans will become infected with COVID-19.

In addition to the lag in official count reporting, demographic information on people who have died isn’t being released.

South Dakota state officials won’t confirm the gender or age range of the people who have died anymore. At a media briefing Monday, they did provide the county of residence, appearing to match up with the reporting of two deaths KELOLAND News reported Friday.

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