The number of people who died of Covid-19 worldwide could be more than three times the official toll, according to an analysis published in the Lancet.
While the official Covid-19 death toll was 5.9 million between January 1, 2020 and December 31, 2021, the new study estimates 18.2 million excess deaths occurred over the same period, suggesting the full impact of the pandemic may have been far greater.
With 5.3 million excess deaths, South Asia had the highest number of estimated excess deaths from Covid-19, followed by North Africa and the Middle East (1.7 million) and Eastern Europe (1.4 million). At the country level, the highest number of estimated excess deaths occurred in India (4.1 million), the USA (1.1 million), Russia (1.1 million), Mexico (798,000), Brazil (792,000), Indonesia (736,000), and Pakistan (664,000). These seven countries may have accounted for more than half of global excess deaths caused by the pandemic over the 24-month period, the authors of the study stated.
Excess deaths – the difference between the number of recorded deaths from all causes and the number expected based on past trends – are a key measure of the true death toll of the pandemic.
Among these countries, the excess death rates were highest in Russia (375 deaths per 100,000) and Mexico (325 deaths per 100,000), and were similar in Brazil (187 deaths per 100,000) and the USA (179 deaths per 100,000). Because of its large population, India alone accounted for an estimated 22% of the global total deaths. India, according to the study, has reported 4.89 lakh deaths with Covid mortality rate being 18.3 per lakh .The total excess mortality, as per the study, is estimated at 40.70 lakh deaths with the excess mortality rate of 152.5 /per lakh. While there have been several attempts to estimate excess mortality from Covid-19, most have been limited in geographical scope by the availability of data. The new study provides the first peer-reviewed estimates of excess deaths due to the pandemic globally and for 191 countries and territories along with 252 sub-national locations such as states and provinces.
The analysis indicates that global excess deaths due to the pandemic may have totalled 18.2 million – more than three times higher than the official reported figure – by December 31, 2021. The excess death rate is estimated to be 120 deaths per 100,000 population globally, and 21 countries were estimated to have rates of more than 300 excess deaths per 100,000 population.
The highest estimated excess death rates were 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 sub-Saharan Africa (309 deaths per 100,000), and Central Latin America (274 deaths per 100,000). In stark contrast, some countries were estimated to have had fewer deaths than expected based on mortality trends in prior years, including Iceland (48 fewer deaths per 100,000), Australia (38 fewer deaths per 100,000), and Singapore (16 fewer deaths per 100,000).
The ratio of excess deaths to reported deaths is far greater in South Asia (excess deaths 9.5 times higher than reported deaths) and sub-Saharan Africa (excess deaths 14.2 times higher than reported) than other regions.
The large differences between excess deaths and official records may be a result of under-diagnosis due to lack of testing and issues with reporting death data. Evidence from initial studies sugTo date, only 36 countries have released data on cause of death for 2020. As data from more countries becomes available, it will be possible to determine in a better manner the number of excess deaths that were directly due to Covid-19.
Lead author of the study, Dr Haidong Wang of the Institute for Health Metrics and Evaluation, USA, said: “Understanding the true death toll from the pandemic is vital for effective public health decision-making. Studies from several countries suggest Covid-19 was the direct cause of most excess deaths, but we currently don’t have enough evidence for most locations.â€
