Global COVID-19 Death Count May Be Three-Fold Greater

Haidong Wang, PhD

New peer-reviewed global estimates of excess deaths during the COVID-19 pandemic suggested that more than 3 times as many people have died worldwide from the virus than what was observed in previous records.

Between January 1, 2020, and December 31, 2021, the official global death toll was believed to be 5.9 million.

However, a new study published in the Lancet estimates that 18.2 million excess deaths occurred in the same period, suggesting that the impact of the pandemic was greater than previously thought.

Excess deaths are crucial to understanding the true death toll of the pandemic, and previous attempts to estimate excess mortality from COVID-19 have been geographically limited due to availability of data.

The present study, led by Dr. Haidong Wang of the Institute for Health Metrics and Evaluation in the US, provided 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.

Wang and fellow investigators obtained data from 74 countries and 266 states and provinces through government websites including the World Mortality Database, Human Mortality Database, and European Statistical Office. This included weekly or monthly data on deaths from all causes in 2021, 2020, and 11 years prior.

Data were then used in models that estimated excess mortality due to the COVID-19 pandemic and included locations with no weekly or monthly reporting of death data.

The analysis estimated the excess death rate to be 120 deaths per 100,000 population globally, and 21 countries were estimated to have 200 excess deaths per 100,000 population.

Rates varied dramatically depending on the country and region. 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).

Several locations including Lebanon, Armenia, and Tunisia had similar excess death rates, as did locations scattered across Italy.

Regarding excess deaths, South Asia had the highest number of estimated excess deaths from COVID-19 with 5.3 million, 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), followed by the USA (1.1 million), Russia (1.1 million), Mexico (798,000), Brazil (792,000), Indonesia (736,000), and Pakistan (664,000).

Investigators noted that these 7 countries might have contributed to more than half of global excess deaths caused by the pandemic.

Among them, the excess deaths rates were highest in Russia (375 deaths per 100,000) and Mexico (325 deaths per 100,000), while similar rates in Brazil (187 deaths per 100,000) and the USA (179 deaths per 100,000) were noted. India accounted for an estimated 22% of the global total deaths.

These sizeable differences in excess deaths and official records could be attributed to under-diagnosis due to lack of testing and issues with reporting death data.

Study authors noted that evidence from initial studies suggested that a significant proportion of excess deaths were a direct result of COVID-19, though deaths may also have occurred indirectly from causes such as suicide or drug use due to behavioral changes or lack of access to healthcare and other essential services during the pandemic.

Only 36 countries have released cause of death data for 2020 so far, and investigators noted that it will be possible to more accurately determine how many excess deaths resulted from COVID-19 and how many occurred as an indirect result of the pandemic or responses to it as data from more countries becomes available.

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