Global COVID-19 deaths may be 3 times higher than recorded

Grieving in hospital hallway
Grieving in hospital hallway

Ivan-balvan / iStock

Today in The Lancet researchers say excess deaths data indicate that the global death toll from the COVID-19 pandemic may be more than three times higher than officially record.

While official counts from countries vary, an estimated 5.9 million COVID-19 deaths were recorded globally in 2020 and 2021. The Lancet study compared that number to weekly or monthly data on deaths from all causes in those 2 years and up to 11 years prior from 74 countries and 266 states and provinces, using government websites, the World Mortality Database, Human Mortality Database, and European Statistical Office.

Excess mortality was calculated as observed mortality minus expected mortality. The authors also excluded weekly death tolls during times of anomalies, such as heat waves, from their calculations.

They estimate that the global COVID-19 death toll is closer to 18.2 million, and the excess death rate caused by the virus is 120 per 100,000 population globally. Some countries may have more than 300 excess deaths per 100,000 population.

Regional hot spots differ

The study showed stark regional differences in excess deaths, with the highest rates seen in Andean Latin America (512 deaths per 100,000 population), Eastern Europe (345 deaths per 100,000), central Europe (316 deaths per 100,000), southern Africa (309 deaths per 100,000), and Central America (274 deaths per 100,000). But several territories outside these regions, including parts of Asia and several southern US states, also had high rates.

The authors said the highest estimated excess deaths at a country level occurred in India (4.1 million), the United States (1.1 million), Russia (1.1 million), Mexico (798,000), Brazil (792,000), Indonesia (736,000), and Pakistan (664,000). Together these countries accounted for almost half of the COVID-19 deaths seen in the past 2 years.

"Our findings indicate that the full impact of the pandemic has been much greater than what is suggested by official statistics," the authors said.

The countries with the fewest excess deaths were Iceland (48 fewer deaths per 100,000), Australia (38 fewer deaths per 100,000), and Singapore (16 fewer deaths per 100,000).

True numbers essential for making decisions

"Understanding the true death toll from the pandemic is vital for effective public health decision-making. Studies from several countries including Sweden and the Netherlands, suggest COVID-19 was the direct cause of most excess deaths, but we currently don't have enough evidence for most locations," said lead study author Haidong Wang, PhD, of the Institute for Health Metrics and Evaluation, in a Lancet press release.

"Further research will help to reveal how many deaths were caused directly by COVID-19, and how many occurred as an indirect result of the pandemic."

The authors of the study also suggest that the huge gap between official death counts and the estimate provided from excess mortality counts points to a need to strengthen death registration systems around the world.

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