Study estimates real global COVID death toll is approaching 20 million

A new study published in The Lancet is offering the first peer-reviewed investigation into the global death toll of COVID-19. By tracking excess death data from nearly 200 countries across 2020 and 2021 the study estimates more than 18 million deaths from COVID-19, a number that is three times higher than official estimates.

Since the pandemic began in early 2020 researches have looked to excess death data as the best way to track the true mortality toll of COVID-19. From year to year total death counts in a given country are generally remarkably consistent. After accounting for growth in population, researchers can identify the impact of events such as natural disasters or wars by looking at the rate of death in excess of what could be normally expected.

Over the last two years researchers looking at excess death data have consistently suggested the official COVID-19 mortality figures are dramatically undercounting the real toll of the pandemic. A study last year estimated the real COVID-19 toll from the first year of the pandemic is likely more than double the official count.

This new study, led by the University of Washington’s Institute for Health Metrics and Evaluation, is the most thorough excess death investigation to be published so far in the pandemic. Weekly or monthly all-cause mortality data spanning 2020 and 2021 was collected from 74 countries and 266 states or provinces. Data was also gathered for the 11 years prior to the pandemic.

This data was used to create several models that could estimate excess death figures from 191 countries and territories. Overall, the researchers calculated 18.2 million excess deaths around the world between January 2020 and December 2021. This contrasts with the official number of 5.9 million COVID-19 deaths over that same span of time.

Haidong Wang, lead author on the study, is cautious to stress these excess death figures are not a direct proxy for COVID-19 deaths. It is likely a portion of the excess death numbers are due to other factors indirectly linked to the pandemic such as delays in access to routine healthcare. However, Wang does note studies looking at countries with robust mortality reporting are indicating the majority of excess deaths are most likely directly due to COVID-19.

“Understanding the true death toll from the pandemic is vital for effective public health decision-making,” said Wang. “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. 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.”

Unsurprisingly, excess death rates differ substantially from country to country. Bolivia was estimated to have one of the highest excess death rates at 734 excess deaths per 100,000 people. Other countries with high excess death rates include Bulgaria (647 per 100,000), Peru (528 per 100,000), Eswatini (634), and Lesotho (562).

Looking at gross excess mortality figures India saw 4.07 million excess deaths with the United States second on the list with 1.13 million excess deaths. The study notes five more countries with excess death figures exceeding 500,000: Russia (1.07 million), Mexico (798,000), Brazil (792,000), Indonesia (736,000) and Pakistan (664,000).

A small number of countries were seen to stand apart from the rest registering below average excess death figures. These countries were primarily regions adopting zero COVID policies, effectively keeping the virus out across 2020 and 2021.

These countries include Singapore (16 fewer deaths per 100,000), Australia (38 fewer deaths per 100,000), and Iceland (48 fewer deaths per 100,000). The researchers hypothesize the below average excess death counts in these countries to be related to reductions in mortality, “from diseases and injuries for which exposure to related risks has been reduced during the pandemic.”

Ultimately, the researchers call for stronger global mortality monitoring systems in order to better track the impact of future pandemics in real-time, as it is becoming increasingly clear the toll of COVID-19 over the past couple of years has been dramatically underestimated.

“The full magnitude of the COVID-19 pandemic has been much greater in 2020 and 2021 than is indicated by reported deaths due to COVID-19, with COVID-19 potentially being a leading cause of mortality in 2020 and 2021,” the researchers write in the study. “Finding ways to strengthen death reporting systems and mitigate political barriers to accurate reporting will be important for tracking and monitoring the continuation of the existing COVID-19 pandemic and future pandemic events.”

The new study was published in the journal The Lancet.

Source: The Lancet