Global Excess Deaths Due To Covid-19 May Be More Than 3 Times Higher Than Official Records: Study

The number of people who have died as a result of the Covid-19 pandemic may be more than three times higher than official records, according to an analysis published in The Lancet.

New Delhi: The number of people who have died as a result of the Covid-19 pandemic may be more than three times higher than official records, according to an analysis published in The Lancet.

The official global death toll of Covid-19 between January 1, 2020 and December 31, 2021 was 5.9 million. As many as 18.2 million excess deaths occurred over the same period, the new study estimates. This suggests that the full impact of the pandemic may have been far greater.

What Are Excess Deaths?

Excess deaths are the difference between the number of recorded deaths from all causes and the number expected based on past trends. Excess deaths are a key measure of the true death toll of the pandemic. 

Though scientists have made several attempts to estimate excess mortality from Covid-19, most studies have been limited in geographical scope by the availability of data.

First Peer-Reviewed Estimates Of Excess Deaths Due To Covid-19

The study published in The Lancet provides the first peer-reviewed estimates of excess deaths due to the pandemic globally and for 191 countries and territories between January 1, 2020 and December 31, 2021. The territories include 252 subnational locations such as states and provinces. 

Through searches of government websites such as the World Mortality Database, Human Mortality Database, and European Statistical Office, weekly or monthly data on deaths from all causes in 2021, 2020, and up to 11 years prior was obtained for 74 countries and 266 states and provinces, according to the study.

Using the data, the researchers estimated excess mortality due to the Covid-19 pandemic, including for locations with no weekly or monthly reporting of death data.

18.2 Million Excess Deaths During 24-Month Period

According to the analysis, the global excess deaths due to the pandemic may have been equal to 18.2 million by December 31, 2021. This is more than three times higher than the official reported figure.

According to the study, the excess death rate is estimated to be 120 deaths per 100,000 population globally. As many as 21 countries were estimated to have rates of more than 300 excess deaths per 100,000 population. The researchers estimated the rates of excess deaths to have varied dramatically by country and region. 

Excess Death Rates Across Different Regions 

According to the study, the highest estimated excess death rates were in Andean Latin America, Eastern Europe, Central Europe, Southern sub-Saharan Africa, and Central Latin America. The excess death rate in Andean Latin America, Eastern Europe, Central Europe, Southern sub-Saharan Africa, and Central Latin America were estimated to be 512, 345, 316, 309, and 274 deaths per 100,000 population respectively. 

According to the study, several locations outside these regions are estimated to have had similarly high rates, including Lebanon, Armenia, Tunisia, Libya, several regions in Italy, and several states in the southern United States of America. 

The researchers, in contrast, estimated that some countries had fewer deaths than expected on mortality trends in prior years. These countries included Iceland, Australia, and Singapore, where the excess death rates were 48 fewer deaths per 100,000 population, 38 fewer deaths per 100,000 population, and 16 fewer deaths per 100,000 population. 

Which Region Had The Highest Number Of Excess Deaths?

South Asia had the highest number of estimated excess deaths from Covid-19 (5.3 million). It was followed by North Africa and the Middle East, which had 1.7 million excess deaths. Eastern Europe had 1.4 million excess deaths. 

Which Country Had The Highest Number Of Excess Deaths?

According to the study, the highest number of excess deaths at the country level occurred in India. As many as 4.1 million excess deaths occurred in India. The USA, Russia, Mexico, Brazil, Indonesia, and Pakistan had 1.1 million, 1.1 million, 798,000, 792,000, 736,000 and 664,000 excess deaths respectively. 

The authors noted in the study that these seven countries may have accounted for more than half of global excess deaths caused by the pandemic over the 24-month period. Among the seven countries, the excess death rates were highest in Russia and Mexico. The excess death rates in Russia and Mexico were 375 deaths per 100,000 and  325 deaths per 100,000 respectively.

The excess death rates in Brazil and the USA were 187 deaths per 100,000 and 179 deaths per 100,000 respectively. India alone accounted for an estimated 22 per cent of the global total deaths, because of its largest population, according to the study.

Which Regions Had A Higher Ratio Of Excess Deaths To Reported Deaths Compared To Other Areas?

The researchers calculated the difference between excess death estimates and official reported deaths to obtain a measure of under-counting of the pandemic's true death toll. The scientists found the ratio of excess deaths to reported deaths to be much greater in South Asia and sub-Saharan Africa than other regions. This is because the number of excess deaths in South Asia was 9.5 times higher than reported deaths, and that in sub-Saharan Africa was 14.2 times higher than reported. 

According to the researchers, lack of testing and issues with reporting death data may be responsible for the large differences between excess deaths and official records.

What Factors Were Indirectly Responsible For Excess Deaths?

The authors said that distinguishing between deaths caused directly by Covid-19 and those that occurred as an indirect result of the pandemic is crucial. According to the study, evidence from initial studies suggests a significant proportion of excess deaths are a direct result of Covid-19.

However, behavioural changes or lack of access to healthcare and other essential services during the pandemic may be indirectly responsible for deaths, according to the study. The authors noted in the study that the impact of these various factors will vary by country and region. 

To date, only 36 countries have released cause of death data for 2020, according to the study. 

Covid-19 Was The Direct Cause Of Most Excess Deaths: Other Studies

It will be possible to better determine the number of excess deaths Covid-19 was directly responsible for and how many excess deaths occurred as an indirect result of the pandemic or responses to it, when data from more countries becomes available. Dr Haidong Wang, lead author of the study, said that understanding the true death toll from the pandemic is vital for effective public health decision-making, according to a statement issued by The Lancet. Covid-19 was the direct cause of most excess deaths, studies from several countries including Sweden and the Netherlands suggest. 

Wang further said that researchers currently do not have enough evidence for most locations. He said that 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.

Limitations To The Study

The authors acknowledged certain limitations to their study, which include the fact that a statistical model was used to predict excess deaths for countries that did not report weekly or monthly data on deaths from all causes. There was a need for direct measurement from these locations.

Another limitation to the study was that excess death estimates were calculated for the full study period only, and not by week or month. According to the authors, this could drastically alter estimates.