Revealing the Toll of COVID-19: A Technical Package for Rapid Mortality Surveillance and Epidemic Response

On Jan. 30, 2020 the World Health Organization (WHO) declared the outbreak of coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern.A Even before this declaration, counts of deaths and cases were a primary means of tracking the growth and trajectory of the pandemic. In particular, graphs depicting excess total mortality by week from countries around the world have been an increasingly common and powerful way to capture and present the impact of the COVID-19 pandemic.

The purpose of this document is to provide practical guidance to implement rapid mortality surveillance (RMS) and measure excess mortality in the context of the COVID-19 pandemic, with a focus on implementation in low-resource settings. This includes settings with largely paper-based systems of data collection.

We define RMS as “a system for generating daily or weekly counts of total mortality by age, sex, date of death, place of death, and place of usual residence.” Excess mortality is the degree to which currently measured mortality exceeds historically established levels. In the context of COVID-19, increases in total mortality are attributed to direct and indirect effects of the pandemic.

While this guidance is COVID-19 specific, the basic concept of rapid mortality surveillance adds to the international architecture of population health surveillance and civil registration and vital statistics (CRVS) systems.