Study estimates more than 18 million died of COVID worldwide

Official death toll is almost 6 million, but excess deaths indicate far more may have died from COVID than reported

An analysis published in The Lancet estimates that more than three times as many people may have died worldwide from COVID than official death records suggest. The official death toll was 5.9 million between Jan. 1, 2020, and Dec. 31, 2021, but there are an estimated 18.2 million excess deaths that occurred over the same period.

Excess deaths are the difference between the number of recorded deaths from all causes and the number expected based on past data. The study provides the first peer-reviewed estimates of excess deaths due to the pandemic. The researchers obtained deaths from all causes data for 74 countries and 266 states and provinces. The data were used in models to estimate excess mortality due to the pandemic.

The analysis indicates that global excess deaths due to the pandemic may have totalled 18.2 million – more than three times higher than the official reported figure – by December 31, 2021. The excess death rate is estimated to be 120 deaths per 100,000 population globally, and 21 countries were estimated to have rates of more than 300 excess deaths per 100,000 population. Rates of excess deaths are estimated to have varied dramatically by 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 outside these regions are estimated to have had similarly high rates, including Lebanon, Armenia, Tunisia, Libya, several regions in Italy, and several states in the southern USA. In stark contrast, some countries were estimated to have had fewer deaths than expected based on mortality trends in prior years, including Iceland (48 fewer deaths per 100,000), Australia (38 fewer deaths per 100,000), and Singapore (16 fewer deaths per 100,000).

With 5.3 million excess deaths, South Asia had the highest number of estimated excess deaths from COVID-19, 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), the USA (1.1 million), Russia (1.1 million), Mexico (798,000), Brazil (792,000), Indonesia (736,000), and Pakistan (664,000). These seven countries may have accounted for more than half of global excess deaths caused by the pandemic over the 24-month period. Among these countries, the excess deaths rates were highest in Russia (375 deaths per 100,000) and Mexico (325 deaths per 100,000), and were similar in Brazil (187 deaths per 100,000) and the USA (179 deaths per 100,000). Because of its large population, India alone accounted for an estimated 22% of the global total deaths.

According to the researchers, the large differences between excess deaths and official records may be a result of under-diagnosis due to lack of testing and issues with reporting death data. Distinguishing between deaths caused directly by COVID-19 and those that occurred as an indirect result of the pandemic is crucial, the authors say. Evidence from initial studies suggests a significant proportion of excess deaths are a direct result of COVID-19. However, deaths may also have occurred indirectly from causes such as suicide or drug use due to behavioural changes or lack of access to health care and other essential services during the pandemic.