According to the British Medical Journal (BMJ), more than three times as many people may have died worldwide as a result of the COVID-19 pandemic than official statistics suggest, according to the first peer reviewed study of global excess deaths.
The research, published in the Lancet, estimates there were 18.2 million excess deaths globally between January 1, 2020 and December 31, 2021 whereas the official death toll was 5.9 million.
The researchers said the mortality impact from the COVID-19 pandemic has been “more devastating” than the situation documented by official statistics which provide only a “partial picture” of the true burden of mortality. Evidence from initial studies suggest a significant proportion of excess deaths are a direct result of COVID-19, the authors said, but more research is needed.
All cause mortality reports were collected for 74 countries and territories and 266 states or provinces through searches of government websites, the World Mortality Database, Human Mortality Database, and European Statistical Office. The data was corrected for lags in reporting and for under-registration of deaths, with weeks with heat waves excluded. An ensemble of six models was used to predict the expected mortality rate in the absence of COVID-19. The model also was used to predict excess mortality rate for locations where all-cause mortality data were not available.
Globally, the excess death rate is estimated to be 120 deaths per 100,000 population with 21 countries estimated to have rates over 300 deaths per 100,000. The highest estimated excess death rates were in Andean Latin America (512 per 100,000 population), Eastern Europe (345 deaths per 100,000), Central Europe (316 deaths per 100 000), Southern sub-Saharan Africa (309 deaths per 100 000), and Central Latin America (274 deaths per 100,000). But there were also high rates outside these regions including Lebanon, Armenia, Tunisia, Libya, several regions in Italy, and several southern US states.
At a country level, excess mortality was highest in Bolivia (734.9 per 100,000), Bulgaria (647.3), and Eswatini (634.9). In Russia there were an estimated 1.1 million excess deaths; a rate of 374.6 deaths per 100 000 population. The US also had an estimated 1.1 million excess deaths with a rate of 179.3 per 100 000 population. An estimated 792,000 excess deaths occurred in Brazil; a rate of 186.9 per 100,000. Because of its large population, India with its estimated 4.1 million excess deaths, accounted for an estimated 22% of the global total deaths.
The UK had an estimated excess mortality rate of 126.8 per 100,000, which was lower than Spain (186.7), Italy (227), and Belgium (146.6) and closer to that of France (124) and Germany (120.5). Some countries were estimated to have had fewer deaths than expected including Iceland (48 fewer deaths per 100 000), Australia (38 fewer deaths per 100,000), and Singapore (16 fewer deaths per 100 000).
The difference between excess mortality and reported COVID-19 deaths might be a result of underdiagnosis because of insufficient testing or higher than expected mortality from other diseases because of behavioral change, or reduced access to healthcare or other essential services. The gap between estimated excess mortality and reported COVID-19 death is much larger in South Asia and sub-Saharan Africa than in other regions.
The study highlights that high burden countries are distributed across all regions of the world, reinforcing the evidence for the truly global nature of the pandemic. Finding ways to strengthen death reporting systems and mitigate political barriers to accurate reporting will be important for tracking this and future pandemics, the authors said.
Lead author Haidong Wang, of the Institute for Health Metrics and Evaluation, said, “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. 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.”