What are the real COVID mortality numbers?

Estimates from WHO are pending; meanwhile a study in The Lancet suggests the true number of global fatalities from COVID may be 3x higher than indicated by official reports.

How many people worldwide have died so far from COVID-19? And, how do we know? Above all, what sources can we rely on for accurate data?

These questions are simple, but reliably establishing the answers is  anything but. A high-quality study released March 10th in The Lancet estimates true mortality from COVID through yearend 2021 was three times higher than the number of deaths reported through official systems.

According to this study, we did not lose 6 million people to COVID in 2020 and 2021. We lost 18 million.

WHO has also been working – with a specially-formed technical advisory group and the UN Department of Economic and Social Affairs – to produce its own estimates. That publication has been delayed by several months. As reported first by Devex, and subsequently by the New York Times, India is pushing back hard against publication. The government of India insists that half a million people in that country have died from COVID – which stands at odds with the four million estimated by the Lancet study (and reportedly also by WHO). 

So for now we do not have the WHO numbers, but we do have the findings of this excellent study. 

The Lancet study’s methodology focuses on “excess mortality” -- observing the number of extra deaths that have occurred above what would normally be expected. The estimated 18 million fatalities lumps together two different types of COVID-related fatalities: first, deaths caused directly by the virus, and second, additional deaths that are attributable to the pandemic’s ripple effects – what we might call indirect COVID fatalities. WHO is using similar methodology. 

Beyond the new study’s eye-catching headline about the actual (total) COVID fatality rate, four things struck us about this report:

---

#1 – COVID in context:

What is the meaning of 18 million COVID-related deaths, in the context of the other leading causes of death? Well, nine million extra deaths a year is a 15% increase. Pre-pandemic, 60 million people died per year. The two leading causes of death every year are cardiovascular disease (i.e., heart attacks, strokes, the lot), which kills some 19 million people; and cancer (again, as a whole) which annually kills 10 million people worldwide. So COVID is now the third leading cause of death globally.

#2 – Direct and indirect COVID fatalities:

As mentioned, the research counts all the “excess deaths” in 2020 and 2021, regardless of whether these excess deaths were a direct or indirect result of COVID. That is as it should be; both categories of COVID-related deaths deserve extremely serious attention.

If hospitals are full of COVID patients, it leads to healthcare service disruptions for everyone else. Non-COVID patients cannot get treated, or can’t obtain full treatment, or they finally receive treatment but it comes too late. Also, fear of the pandemic makes people afraid to enter a hospital, and so on. All of these are COVID fatalities, too, just in a different sense.

We all know this, but its importance is often overlooked. During my tenure at UNICEF, I commissioned a study on how pandemic-driven service disruptions measurably increased fatalities across a population. Our research estimated there was a 15% increase in child and maternal mortality in South Asia in 2020 compared to 2019, because of service disruptions and reduced use of services.

#3 – Flying blind?

This research into the true numbers of COVID fatalities (and the fact that it is even needed; that we can’t rely on the official statistics at all) underlines a huge and basic gap in the system. Death registration is suboptimal in all countries, weak in many, and non-existent in some.

Birth registration is a bit better, but still has big holes – a fact that is highly relevant here. You can’t register a death, or accurately evaluate its significance, if you didn’t know that person was alive in the first place. Therefore, many jurisdictions cannot set up reliable fatality tracking, because they lack a reliable national census or population registration system.

This is yet another example of a basic part of the global healthcare system that isn’t working well. It’s something we live with year after year, but that means we have been “flying blind” during this global emergency.

I was interested to see the former directors of the U.S. Centers for Disease Control (CDC) calling out the adverse impact that a lack of timely, standardized data has had during the pandemic. That’s in the USA --- the situation in many low- and middle-income countries is far worse.

#4 – What else are we undercounting?

If we have been substantially undercounting global COVID-related deaths, that prompts a troubling question. What else are we undercounting? What about the broader health impact of COVID -- the mental health burden, the growing challenge of Long COVID (now and into the future), and those patients who simply get sick from COVID but do not die or become hospitalized?

Deaths are, in a sense, the tip of the iceberg.

Let’s see how much longer passes before WHO is able to release its equivalent estimates. One lesson for the future - fuller, more accurate, more reliable data about the basic facts of our situation has got to be part of our first line of defense. 

---

GLOBE is an outlet that allows colleagues and friends of the ApiJect Global Initiative to share their thoughts on matters related to global health and their ongoing work. Send questions or responses to media@apijectglobal.com.

To learn more about the ApiJect Global Initiative, visit our website
Twitter | LinkedIn | YouTube