Updated COVID-19 Global Death Toll Estimate Is Three Times What Records Indicate

Reviewed by Erica Stohs, MD, MPH, University of Nebraska

In this Lancet study, investigators estimate an excess mortality of 18.2 million deaths worldwide due to the COVID-19 pandemic between 2020-2021, although just 5.9 million are reported. Their estimate is based on a combination of six models that utilize previously unavailable data encompassing 74 countries. They also corrected for time-sensitive climate changes, including heat waves specifically, that might over-estimate deaths. 

Eighteen million excess deaths due the COVID-19 pandemic occurred over a 2-year period, or 120.3 (113-129) deaths per 100,000. Not surprisingly, resource-poor countries yielded higher estimates. Thirty-one countries total had rates of >300 per 100,000 with Bolivia suffering the worst (est. 735 deaths per 100,000). Meanwhile, some countries had negative excess mortality: Iceland, Australia, Singapore, New Zealand, and Taiwan. Cumulative excess deaths topped 1 million for 3 countries: India (4.07 million), US (1.13 million), and Russia (1.07 million). Of note, the rate for the US was 179 per 100,000 and state-based estimates were provided. 

Investigators, funded by the Gates Foundation, suggest that more accurate mortality estimates are needed for public health decision making. The only other comparable model was put forth by The Economist. Authors acknowledged difficulty parsing out global trends of other potential causes of excess mortality (or survival) that some countries report. For example, traffic/injury-related deaths and air pollution-related events may have decreased during lockdowns, while suicide trends and chronic disease-related deaths varied between nations. It is also difficult to model how lack of health care resources during the pandemic would have led to excess mortality due to non-COVID-19 causes, particularly in sub-Saharan Africa and SE Asia. In summary, this study offers a grim, updated snapshot of the COVID-19 pandemic death toll.

Reference: COVID-19 Excess Mortality Collaborators. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21. The Lancet 2022;399:1513-36. DOI: https://doi.org/10.1016/S0140-6736(21)02796-3.

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