Honors Program

Midway Honors

Date of Award


Thesis Professor(s)

Randy Wykoff

Thesis Professor Department

Health Services Management and Policy

Thesis Reader(s)

Randy Wykoff


Background: In late 2019, the SARS-CoV-2 virus was identified in Wuhan, China. Within a matter of weeks, the virus spread to the United States and many other countries around the world. By March 5, 2020, the first case of COVID-19 (the disease caused by the SARS-CoV-2 virus) was identified in the state of Tennessee, and the first known COVID-19 associated death in the state followed on March 20, 2020. In 2020 alone, there were 514,922 confirmed cases and 6,760 COVID-19 attributed deaths in the state of Tennessee. It is important to understand, however, that confirmed COVID-19 deaths do not accurately capture the overall impact of the COVID-19 pandemic. Many additional deaths resulted either directly from COVID-19 disease, or indirectly from the COVID-19 pandemic. This report seeks to briefly summarize the early stages of the COVID-19 pandemic and its immediate impact on the state of Tennessee and outline a novel tool for rapidly identifying excess mortality using publicly available data.

Methods: Calculating excess mortality is likely to accurately capture the total deaths that occurred because of the COVID-19 pandemic, including deaths that may not have been directly attributed to COVID-19 disease. To calculate excess mortality, four years (2017-2020) of data were collected from three sources, online funeral home listings, newspaper obituaries, and the state health department. Using simple linear regression, number of deaths by month for 2017, 2018 and 2019 were used to predict expected deaths, by data source, for each month of 2020 as the baseline for comparison. The percent difference of actual deaths from the expected deaths was then calculated and compared by data source.

Results: By quarter, 2020 actual funeral home listings differed from the expected by Q1:-9.29%, Q2:11.50%, Q3:7.36% and Q4:55.90%. Newspaper obituaries differed from the expected by Q1:8.05%, Q2:20.00%, Q3:9.93% and Q4:44.55%. State reported Washington County data differed from the expected by Q1:7.68%, Q2:18.85%, Q3:12.21%, Q4:48.91%.

When comparing online funeral listings and newspaper obituaries to state reported data for Washington County, it is clear that either of the public data sources could have been used to identify spikes in excess mortality throughout 2020.

Conclusion: These findings reveal that publicly available online funeral home death listings and local newspaper obituaries can be used as a tool to help identify spikes in excess mortality in ‘real-time’. The most notable impact being that the newspaper obituary and funeral home data was available in near real time, whereas the state reported Washington County data was not made available until October of 2021.


East Tennessee State University

Document Type

Honors Thesis - Withheld

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.


Copyright by the authors.