[rallison]

> This was publicly admitted to by Toronto Public Health itself, as early as June 2020:

> "Individuals who have died with COVID-19, but not as a result of COVID-19 are included in the case counts for COVID-19 deaths in Toronto."

I don't know the particulars of Toronto Public Health, but this wasn't uncommon for immediate reporting vs death record reporting. Since, in many places, comprehensive death records can take a few weeks (or longer!) to go through the pipeline before ending up on finalized reports, it's useful to have more immediate death reporting during a pandemic. Such immediate reporting is necessarily going to be a little rougher around the edges, but it generally gets you pretty close to the real numbers.

But, it's absolutely true that this immediate reporting isn't perfect. Still, it's very useful, and usually close enough for near term needs. Taking the Toronto example, the main tradeoffs are that a) you include some deaths where Covid wasn't actually a contributing factor and b) you miss deaths where the person was never tested for Covid (especially applicable to deaths that occurred at home). Often, these two somewhat balanced themselves out, but only in places with fairly high levels of testing.

Then, in the medium to longer term, you can switch over to relying on more comprehensive death records. This helps to filter out non-causal scenarios (e.g. the "hit by bus, tested positive for covid, died" scenarios). It also helps add in cases that were initially missed (had symptoms of covid, never went to hospital, died at home, etc).

Finally, to validate numbers, we can also look at excess deaths. This helps ensure that we're not wildly off base with reported numbers. Excess deaths isn't a perfect metric to compare to, but it's still a great benchmark.

To wrap up this comment, let me respond to this:

> We have to be extremely cautious when considering any of the death-related statistics for this particular situation.

I fully agree, but.. I would suggest that your comment missed a lot of the accuracy refinement that happens in practice over the medium to longer term. Additionally, it's very much worth pointing out that, with additional analysis (from death records, from excess death analysis, etc), we've found that very few places were likely over-reporting Covid deaths, but that a significant number of places were under-reporting Covid deaths. So, yes, take shorter term Covid death stats with a grain of salt, but know that we've generally ended up reporting too low, not too high.