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Rapid Mortality Surveillance of COVID-19 Using Verbal Autopsy

Identifying causes of death, and especially COVID-19-specific mortality, is a challenge in many low- and middle-income countries. Lack of testing and large numbers of community deaths without a physician to medically certify the cause of death are barriers to knowing the full impact of the pandemic on mortality. Verbal autopsy is a technique for determining the most medically likely causes of death, where no physician is available to complete a medical certificate of cause of death. Verbal autopsy uses a structured questionnaire to elicit the signs and symptoms exhibited by the deceased in the period before death, which can reliably be understood by and reported on by family members and other lay caregivers. The pattern of responses to the questionnaire is used by physicians or a computer algorithm to assign the most probable cause of death. This study analyzed the reliability of a particular model of verbal autopsy for estimating the probability that the causes of 112 deaths in São Paolo, Brazil, were associated with COVID-19.