A country-by-country analysis of mortality in 2020 and 2021, compared to previous years, indicates the death toll from the COVID-19 pandemic may have been more than three times higher than official statistics. "Excess deaths" indicate more than 18 million people died in the first two years of the pandemic. However, the authors of the study acknowledge disentangling deaths from COVID itself and the social disruptions it caused needs more work.
Almost from the beginning of the pandemic official statistics for COVID-19 deaths have been questioned. Disease deniers have claimed many people were being included who died “with COVID, not from COVID” pointing to cases where individuals died from other things, but were counted in the COVID-19 numbers. The number of people who died at home before tests were widely available also has to be taken into consideration. As do those who died in countries that didn't have widespread testing or have large rural populations, or died in the early days of the pandemic before doctors were familiar with characteristics that make a fatal case of COVID.
To get to the bottom of this epidemiologists looked at the number of “excess deaths” — deaths over a certain period of time that are above the average baseline mortality rate — cities and entire countries experienced during major waves of the pandemic. Now more than 100 researchers have come together to do this for the entire world. Their findings, published in The Lancet, reach a grim conclusion: COVID-19 had killed 18.2 million people — directly and indirectly — by the end of 2021, establishing it as one of history's worst plagues. And this was before most of the Omicron wave's effect had been felt.
“Understanding the true death toll from the pandemic is vital for effective public health decision-making,” said lead author Dr Haidong Wang of America's Institute for Health Metrics and Evaluation in a statement.
In the pandemic's first wave, when tests for the virus were hard to come by, excess death statistics generally painted a much worse picture than official accounts of COVID-19 deaths. The numbers dying untested were greatly exceeding those who died from other causes but had mild COVID cases that wound up being listed on the death certificate.
As tests became more widely available the two sets of numbers started to align more closely in rich countries. However, in South Asia and sub-Saharan Africa mortality has greatly exceeded previous years, a fact poorly reflected in official reporting of COVID-19 deaths.
Although this has been widely suspected, the sheer scale of the discrepancy revealed in the paper is a shock. “Although reported COVID-19 deaths between Jan 1, 2020, and Dec 31, 2021, totaled 5·94 million worldwide, we estimate that 18·2 million people died worldwide because of the COVID-19 pandemic over that period,” the paper states.
Of these 4.1 million were in India, compared to 490,000 officially recorded, 1.1 million in Russia (670,000) and 800,000 in each of Mexico and Brazil. Although the United States had slightly more excess deaths than Russia, three quarters of these were captured in the official data. On a per capita basis Russia's death rate was almost twice that of the USA (375 per 100,000 to 179). The Andes were even worse, losing 512 people per 100,000 or 0.5 percent of their population to the disease.
The gap between the official data and the excess deaths is proportionally greatest in sub-Saharan Africa, with 14 times more excess deaths than official records suggest. India's horrific excess death rates have been reported before, but there has been much less focus on Africa.
Inevitably some will blame not the disease itself, but government responses, particularly in the form of lockdowns or vaccinations. However, as with previous studies they build on, the authors show that countries that locked down hard enough to prevent the virus really taking hold had few excess deaths. Some, such as New Zealand, had fewer people die during lockdowns than in the equivalent months of previous years. The authors also excluded periods where natural disasters caused spikes in deaths, such as a European heatwave.
Nevertheless, many of the deaths, particularly in the poorest countries, may be the result of disruptions to the food supply or medical systems that affected even those who never catch COVID-19 themselves. The authors acknowledge they have not been able to calculate how important a factor this was, other than noting it “will vary by country and region.”
Eighteen million deaths would still put COVID-19 behind smallpox, bubonic plague, the “Spanish Flu” and HIV on the list of all-time lethal killers but as the official COVID death toll passes 6 million, we know there are higher numbers to come.