When COVID-19 is the immediate cause of death even if there were underlying conditions, it is to be reported on line 1 of the death certificate. Furthermore, CDC guidance includes "suspected" COVID-19, which means that it can be reported without testing.
"When COVID–19 is determined to be a cause of death, it is important that it be reported on the death certificate to assess accurately the
effects of this pandemic and appropriately direct public health response".