An image shared on Instagram claims any death that occurs within 20 days of a positive COVID-19 test result is counted as a COVID-19 death.

Verdict: False

There is no indication that deaths that occur within 20 days of a positive test are automatically classified as COVID-19 deaths; neither the Centers for Disease Control and Prevention (CDC) nor the World Health Organization (WHO) guidance for counting COVID-19 deaths mentions a 20-day rule. Local physicians, medical examiners or coroners determine and report the cause of death for an individual.

Fact Check:

COVID-19, the disease caused by the novel coronavirus, has killed over 577,000 people in the U.S. to date, according to the CDC.

In recent days, Instagram users have been sharing a screen grab of a May 2 tweet from the Twitter account @Anthea06274890 that attempts to suggest the COVID-19 death tally is being inflated. The tweet reads, “Funny isn’t it, if you die within 20 days of testing positive for the Rona (no matter what other factors were involved) You’ll be counted as a COVID death. However, if you drop dead within 24 hours of taking the vaccine it has nothing to do with it.”

Check Your Fact didn’t find any indication a rule about classifying deaths that occur within 20 days of a positive COVID-19 test result as COVID-19 deaths “no matter what other factors were involved” exists. (RELATED: Will The FDA Not Authorize Or Approve Any COVID-19 Vaccine?)

The CDC’s national COVID-19 death tally comes from state and local death certificate data through the National Center for Health Statistics (NCHS). The death certificate process differs from state to state, as there is no federal law dictating the process, according to a report from the Congressional Research Service. How states count COVID-19 deaths can vary, but there’s no evidence any state has a rule like the one described in the tweet.

When a person dies, the local physician, medical examiner or coroner charged with determining the cause of death reports the cause on the death certificate, according to the CDC website. The physician, medical examiner or coroner who reports the cause of death on a death certificate is “asked to use their best medical judgment based on the available information and their expertise,” the CDC website states.

“In order for COVID-19 to be listed on the death certificate, the infection must have caused or contributed to the death. It is not just a matter of having a positive test,” James Gill, the president of the National Association of Medical Examiners, explained in an email to Check Your Fact. “The cause of death should not be based on an arbitrary cutoff (like 20 days) of a positive test. In order to include COVID-19 on the death certificate, the COVID-19 infection must play a role in causing or contributing to the death regardless of the number of days following the positive test result.”

As Gill mentions, COVID-19 can be listed on a death certificate as the underlying cause of death or a contributing factor. In at least 90 percent of the total deaths attributed to COVID-19 on death certificates through the week ending May 1, the disease was listed as the underlying cause, according to the CDC.

Both the CDC and the WHO provide guidance on how health authorities should count COVID-19 deaths, but neither organization mentions automatically counting deaths that occurred within 20 days of a positive test as COVID-19 fatalities. The CDC’s guidance specifically states that “COVID-19 should not be reported on the death certificate if it did not cause or contribute to the death.”

The notion that COVID-19 deaths in the U.S. are being overcounted is inconsistent with excess mortality data. An analysis from The New York Times found that about 574,000 more people in the U.S. died from March 2020 to early 2021 than would have in a normal year.

The CDC and Food and Drug Administration (FDA) also monitor for and investigate reports of deaths that occur after COVID-19 vaccinations through efforts such as the Vaccine Adverse Event Reporting System. CDC and FDA physicians “review each case report of death as soon as notified and CDC requests medical records to further assess reports,” according to the CDC website.

The CDC website states that COVID-19 vaccines “are safe and effective.” As of May 7, over 254.7 million doses of COVID-19 vaccines have been administered in the U.S., according to the CDC.