Example 1: a patient is admitted to the hospital with congestive heart failure. After 2 weeks in intensive care he contracts Covid-19, and 5 days later he dies. The doctors code cause of death as the virus, when he was already dying. Example 2: a patient is admitted to the hospital with Covid-19. After fighting the virus for a week she is improving, but then she develops bacterial pneumonia, or influenza, or some other disease which causes her to rapidly worsen, and 4 days later she dies. Doctors don't do an autopsy, but she tested positive upon admittance, so they code the cause of death as Covid-19. There are 2 broad types of examples of how the coding guidance does and will lead to overstating the mortality rate of this virus. When you add in the fact that some doctors are motivated to want more PPE or whatnot, and bumping the numbers upward to make Covid-19 look more serious will aid them in getting things, I think the loose language in the NVSS advisory is a permission and an encouragement to overstate the mortality rate of the virus.