Changes in COVID-19-related death certification practices and quality of cause-of-death reporting in the United States from 2020 to 2023
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A 2026 U.S. death-certificate study found declining quality of causal-sequence reporting from 2020 to 2023, confirming that certification quality was imperfect and changed over time.
This supports caution about individual certificates but does not establish a substantial net national overcount from incidental infection.