Measuring misclassification of Covid-19 as garbage codes: Results of investigating 1,365 deaths and implications for vital statistics in Brazil

The purpose of this article was to quantify the amount of misclassification of the Coronavirus Disease-2019 (COVID-19) mortality occurring in hospitals and other health facilities in three Brazilian state capitals, discuss potential factors contributing to this misclassification, and consider the implications for vital statistics. Hospital deaths assigned to causes classified as garbage code (GC) COVID-related cases (severe acute respiratory syndrome, pneumonia unspecified, sepsis, respiratory failure and ill-defined causes) were selected in three Brazilian state capitals. After extrapolating the study results for national GC-COVID-related deaths, the researchers inferred that the burden of COVID-19 disease in Brazil in official vital statistics was probably underestimated by at least 18% in the country in 2020.