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Revealing the Toll of COVID-19: New Guidance Helps Governments Uncover the True Scale of the Pandemic

Rapid mortality surveillance provides real-time data to decision makers, to enhance outbreak surveillance and response planning

May 21, 2020 (NEW YORK) — In the months since the World Health Organization declared COVID-19 a pandemic, two indicators have emerged as paramount to coordinating an effective response: the number of cases and the number of deaths, as reported on national and global dashboards. Yet these indicators are challenging to measure and reflect only a portion of the burden and distribution of the outbreak. To support national governments in enhancing their outbreak surveillance and response planning, Vital Strategies has launched today a new technical package to help guide governments in rapid mortality surveillance, informing decision-making based on the true impact of COVID-19 within their countries. 

Limited capacity for COVID-19 testing in low- and middle-income countries makes it challenging to use confirmed cases as a measure of epidemic impact and burden. The new guidance, Revealing the Toll of COVID-19: A Technical Package for Rapid Mortality Surveillancebuilds on existing surveillance and national civil registration and vital statistics (CRVS) systems wherever possible, providing fit-for-purpose guidance for implementation in low- and middle-income countries. 

“In the absence of adequate global testing capacity, measuring cases and deaths specifically due to COVID-19 is not straightforward,” said Dr. Philip Setel, Vice President of the Civil Registration and Vital Statistics Program at Vital Strategies. “Rapid surveillance of total mortality can provide critical data to national leaders and health authorities as they work to temper and control the pandemic within their borders. The approach described in the technical package adds an important level of awareness of the COVID-19 epidemic’s trajectory and health impacts, and does so with speed and simplicity.”

Rapid mortality surveillance generates daily or weekly counts of total mortality by age, sex, date of death, place of death and place of usual residence, providing a fuller picture of the scale and direction of the pandemic, including deaths due to COVID-19 unable to be confirmed. This also includes indirect mortality burden caused by disruptions to access and use of health services, and the interaction of the virus with pre-existing conditions such as noncommunicable diseases. 

The Revealing the Toll of COVID-19 technical package contains step-by-step guidance on the collection, analysis and use of all-cause mortality data collected through facility- or community-based surveillance. The latter is especially important where a significant number of deaths are either known or suspected to be occurring at home—the norm in many low- and middle-income countries, and a situation that may worsen should local health systems become overwhelmed. 

“All countries need timely and reliable data to inform health planning. This need becomes particularly acute at times like now when they face a swiftly evolving pandemic,” said Dr. Samira Asma, Assistant Director General for Data, Analytics, and Delivery for Impact at the World Health Organization. “The WHO stands ready to support all Member States to rapidly improve their capacity to conduct surveillance and strengthen their health information systems.” 

Weekly graphs show policy makers the total number of excess deaths occurring during the epidemic when compared to historical levels, and can quickly be further analyzed by age group, sex or location. This is an increasingly common and powerful way to capture and present the impact of the pandemic. Rapid surveillance of mortality can quickly produce these data for outbreak surveillance and response planning at the national level. Armed with this information, national governments can pinpoint trends in mortality attributable directly or indirectly to COVID-19—beyond the potentially misleading number of deaths confirmed by testing alone.

Through the Bloomberg Philanthropies Data for Health Initiative, Brazil, Colombia and Peru have already begun using existing civil registration and vital statistics systems for rapid mortality surveillance. Digitized access to vital registration data made possible a snapshot of excess mortality in Manaus, Brazil; a sharp increase in total mortality in April 2020 compared to the same time in 2019 illustrates the enormous impact the pandemic has had on the city’s death rate.

“Governments need timely, reliable data to inform decisions that will ultimately save lives, now more than ever,” said Dr. Kelly Henning, head of Bloomberg Philanthropies’ public health programs. “This new technical package will empower leaders around the world with a faster, more accurate understanding of potential COVID-19 deaths, and allow them to take action to slow the spread of this pandemic.”

The technical package was developed with technical experts from Vital Strategies and partner organizations that helped shape the package, ensuring clarity, rigor and ease of use: Africa Centers for Disease Control and Prevention, Bloomberg Philanthropies Data for Health Initiative, CDC Foundation, Pan American Health Organization, UN Economic Commission for Africa, UN Economic and Social Commission for Asia and the Pacific, US Centers for Disease Control and Prevention, and the World Health Organization. 

To access the guidance, visit:


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About Vital Strategies

Vital Strategies is a global health organization that believes every person should be protected by a strong public health system. We work with governments and civil society in more than 70 countries to design and implement evidence-based strategies that tackle their most pressing public health problems. Our goal is to see governments adopt promising interventions at scale as rapidly as possible. To find out more, please visit or Twitter @VitalStrat.

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About the Bloomberg Philanthropies Data for Health Initiative 

The Data for Health Initiative is a global effort supported by Bloomberg Philanthropies and the Australian Department of Foreign Affairs and Trade. It provides technical assistance to low-and middle-income countries worldwide to improve public health data systems at the national level, including improving civil registration and vital statistics systems, maximizing the use of data to enhance public health policymaking and decision-making, establishing and strengthening national cancer registries, and more. The Rapid Mortality Surveillance technical package is also part of the Bloomberg Philanthropies COVID-19 Global Response Initiative implemented by Vital Strategies.