However, because it can take several weeks for death certificates to be submitted and processed, there is on average a delay of 1–2 weeks before they are reported.

We have a very heterogeneous pandemic experience right now -- different parts of the country and different states are experiencing very different things,” said Jeffrey Morris, director of the division of biostatistics at the University of Pennsylvania’s Perelman School of Medicine. “It is kind of a paradox.”

So while it’s too early to see what the recent surge’s death toll will be, if the exponential growth in cases continues unabated, increased deaths are all but inevitable.

“This particular part of the epidemic is just taking off, and we’re still on the runway,” said Thomas Giordano, chief of infectious diseases at Baylor College of Medicine in Houston. “The last thing to happen is the death. We just aren’t that far along with this one yet.”

Time Lag

Deaths are the ultimate lagging indicator, especially with Covid-19. It takes several weeks after a diagnosis for a patient to die. Then it takes more time, sometimes weeks, for doctors to fill out death certificates and health officials to adjudicate the deaths. Only then are they finally added to the official state tally.

“You can’t look at deaths as an indicator of where the outbreak is at this particular period of time,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

Waiting for data to roll in requires “patience that is hard to muster during a crisis,” said Joe Gerald, an associate professor of public health policy and management at the University of Arizona. But “if you want reliable, complete data, you have to wait for it, especially on deaths.”

In Arizona, the time between diagnosis and death from Covid-19 now is about 14 or 15 days, up from four or five days early in the pandemic. Then the state health department must verify the death, so there can be a three-plus week lag between a new case and a fatality being reported, Gerald said.=12pt =12pt