The Lancet: Global Covid-19 death toll ‘may be three times higher than official figures’ - 18.2 million people

The Guardian reports on a study published in The Lancet.

The Covid-19 pandemic may have claimed 18.2 million lives around the world, more than three times the official death toll, a new study suggests.

The higher figure is a better estimate of the true global casualty figure to the end of 2021, according to an analysis by a consortium of health researchers published in the Lancet.

They have based their calculation on the number of “excess deaths” which they believe were caused directly or indirectly by the pandemic. These are calculated by looking at the difference between the number of deaths recorded from all causes and the number of expected based on previous patterns.

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“Our estimates of Covid-19 excess mortality suggest the mortality impact from the Covid-19 pandemic has been more devastating than the situation documented by official statistics,” say the co-authors, who were led by Dr Haidong Wang, an associate professor of health metrics sciences at the University of Washington.

“Official statistics on reported Covid-19 deaths provide only a partial picture of the true burden of mortality. While the official Covid-19 death toll was 5.9 million between 1 January 2020 and 31 December 2021, the new study estimates that 18.2 million excess deaths occurred over the same period, suggesting the full impact may have been greater.”

The research is based on what Wang and his collaborators say are the first peer-reviewed estimates of excess deaths due to the pandemic in 191 countries and territories.

Previous research from Sweden and the Netherlands has found that Covid-19 directly caused most of the excess deaths found there.

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If their estimate is correct, then “the global all-age rate of excess mortality due to the Covid-19 pandemic was 120.2 deaths per 100,000 of the population and [the] excess mortality rate exceeded 300 deaths per 100,000 of the population in 21 countries”.

Globally, South Asia (5.3m), north Africa and the Middle East (1.7m) and eastern Europe (1.4m) had the largest number of excess deaths.

In terms of absolute numbers, India had more excess deaths due to Covid-19 than anywhere else – 4.07m – according to the findings. It was followed by the US (1.13m), Russia (1.07m), Mexico (798,000), Brazil (792,000), Indonesia (736,000) and Pakistan (664,000).

For the UK, the report’s estimated excess Covid deaths (163,000 to 174,000) was close to the reported figure of 173,000.

The five highest estimated excess mortality rates per 100,000 people were seen in Bolivia (734.9), Bulgaria (647.3), Eswatini (634.9), North Macedonia (583.6) and Lesotho (562.9).

Differences between official figures for Covid-related deaths and the researchers’ estimates could be due to a lack of testing, challenges in reporting such deaths, or inability to access healthcare because the pandemic disrupted services, the authors say. That gap is largest in south Asia and sub-Saharan Africa.

They developed a statistical model to measure excess deaths in countries where all-cause mortality data were unavailable, which has enabled them to generate their figure of 18.2 million deaths. They also excluded weeks in which heatwaves occurred, so as not to skew the figures.

“A key finding from our study is that the totality of mortality impact from the pandemic is way beyond the reported Covid-19 death count,” Wang said. “Our analysis wouldn’t have been possible without the promptly reported all-cause mortality data by week/month from so many countries. These data are critical in assessing disease burden and the state of population health in any country”.

Overcoming the “political barriers to accurate [death] reporting” is necessary in countries where they exist in order to track true death tolls from future pandemics, the Lancet paper argues.

“However, many countries still do not have a functioning vital [deaths] registration system. What happened during the pandemic demonstrated the need for both civil and vital registration systems and a disease surveillance system”.