Study finds three times as many people may have died from Covid globally

A new study has revealed the true toll of Covid-19 and has found death rates may be three times higher than official records show.

Around 18.2 million people may have died from Covid during the pandemic so far – more than three times higher than official records – a new study has found.

The peer-reviewed study, published in The Lancet today, looked at excess death rates globally and found the true toll could be much higher than official records suggest, particularly in South Asia and sub-Saharan Africa.

It also identified seven countries that may account for more than half of all excess deaths.

The new study provides the first peer-reviewed estimates of excess deaths globally and includes figures for 191 countries and territories.

Deakin University epidemiologist Associate Professor Hassan Vally said excess deaths was a robust measure of the impact of the pandemic, as not all countries had good disease surveillance systems to record deaths accurately and this could lead to undercounting.

Excess death rates look at whether the number of deaths in each country (from all causes) is higher than what is expected based on historical figures. In many countries this has revealed much higher than expected deaths during the pandemic.

Prof Vally said low to middle income countries, in particular, may not have the resources to record the cause for every death and may not be testing widely for Covid.

Across the world, the number of deaths directly attributed to Covid-19 in the two years from January 1, 2020 to December 31, 2021, was 5.9 million, for a mortality rate of 39.2 per 100,000.

But the study found there were 18.2 million more deaths than expected in that period, suggesting the number of Covid deaths was actually much higher.

Excess deaths in seven countries in particular may have accounted for more than half of these.

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Excess death figures show global death toll from Covid-19 may be three times higher than official figures suggest. Picture: Olga Maltseva/AFP

Seven countries account for half excess deaths

During the pandemic, the highest number of estimated excess deaths occurred in India, which battled a devastating Covid outbreak last year, with experts now estimating the country recorded 4.1 million excess deaths.

This was followed by the United States (1.1 million), Russia (1.1 million), Mexico (798,000), Brazil (792,000), Indonesia (736,000), and Pakistan (664,000).

Regionally, the highest number of estimated excess deaths were recorded in South Asia, where 5.3 million extra people died, followed by North Africa and the Middle East (1.7 million), and Eastern Europe (1.4 million).

Scientists have warned that figures for excess deaths do not mean these deaths were caused directly by Covid-19 as some may have also occurred indirectly due to responses during the pandemic.

It’s possible there were deaths due to suicide or drug use stemming from behavioural changes such as lockdowns, or from lack of access to healthcare and other essential services during the pandemic. The impact of these various factors will vary by country and region.

Covid deaths in places like India appear to have been undercounted by up to 4.1 million people. Picture: Naveen Sharma/SOPA Images/LightRocket via Getty Images

“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,” lead author Dr Haidong Wang, of the Institute for Health Metrics and Evaluation, in the United States, said.

“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.”

So far only 36 countries have released cause of death data for 2020 and as more nations confirm their figures, experts will be better able to judge how many were due directly to Covid and how many were due to indirect causes.

Prof Vally said the excess death figures show Covid-19 is much worse than the flu.

“You’d never expect 18 million people to die globally during a bad flu year,” he said.

“These figures support the idea that Covid-19 is much more severe than the flu.”

Australia recorded fewer than expected deaths

Globally, excess deaths were estimated to be 120 deaths per 100,000 population, although this figure varied dramatically depending on the country and region.

In Australia, there were actually 18,100 fewer deaths than would normally be expected, so its rate was -37.6 per 100,000. Its rate was second only to Iceland on -47.8 per 100,000.

Deakin University epidemiologist Associate Professor Hassan Vally said the data showed how well Australia had done during the pandemic.

Figures show Australia’s measures to control the pandemic worked. Picture: NCA NewsWire/Jeremy Piper

“One of the debates, especially early on in the pandemic, was that the cure was worse than the disease,” Prof Vally said.

“There was a small proportion of commenters saying all the things we were doing to control the disease would have a greater effect on causing deaths than Covid.

“This is really strong data that contradicts that view, and is an indicator that despite how difficult it’s been, we’ve done a pretty good job, especially compared to other countries.”

Prof Vally said the data clearly showed deaths from causes other than Covid had fallen in Australia.

This could be for many reasons, including a possible reduction in road and accident deaths as people were less mobile, and better infection control practices among the general population.

Prof Vally said these practices had seen flu, which can cause a significant number of deaths each year, “largely disappear”.

At the other end of the spectrum, Bolivia recorded 161,000 more deaths than expected, giving it an excess death rate of 734.9 per 100,000.

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 outside these regions also had similarly high rates, including Lebanon, Armenia, Tunisia, Libya, several regions in Italy, and several states in the southern United States.

Overall, rates in 21 countries were higher than 300 per 100,000 population.

Rates vary wildly across the United States

The figures also show Covid death rates could vary dramatically within countries.

In the US, where 824,000 Covid deaths have been recorded, there was an overall mortality rate of 130.6 per 100,000 and an excess mortality rate of 179.3.

But states such as Mississippi had a much higher Covid mortality rate (190 per 100,000), while New York had a rate of 155.8 per 100,000.

The lowest was in Vermont on 39.2 deaths per 100,000, and Hawaii on 39.7 per 100,000.