The COVID-19 pandemic caused far more death and destruction in its first two years than official numbers indicate, a new study from the World Health Organisation has found. The authors estimate that there were about 15 million excess deaths linked to the pandemic in 2020 and 2021, with a likely majority of these deaths the direct result of infection from the coronavirus. Remarkably, excess deaths were even higher in 2021, despite the emergence of several vaccines highly effective at preventing severe illness.
Scientists have known since early on in the pandemic that the official death counts were an underestimate. Available testing for the virus was scarce throughout the world at first, making it difficult to officially tie a person’s death to the infection. And even as wealthy countries got better at documenting deaths over time, countries with poorer health care systems might have continued to struggle. Some countries have also been accused of intentionally underreporting deaths, providing numbers that don’t seem to line up with data collected elsewhere.
The most common way to try to account for these hidden pandemic fatalities has been to measure a country’s excess deaths — deaths above the expected baseline of mortality, usually estimated by looking at average deaths in past recent years. Various researchers and organisations have been collecting and reporting excess death data since 2020. But the WHO’s new estimates, published in Nature on Wednesday, are some of the most comprehensive for first two years of the pandemic on a global scale.
The researchers, led by statistician William Msemburi, calculated the excess mortality of more than 200 countries and territories — no easy task, since only a slight majority of these nations (52%) had death data on a national level available to analyse. For the other, often lower income countries, the team either had to cobble together local sources of data or use data from other countries to model expected and excess mortality.
All told, they estimate there were most likely 14.83 million excess deaths associated with the pandemic in 2020 and 2021, or nearly three times the 5.4 million COVID-19 deaths officially reported during that same time. For some context, the 1918 flu pandemic is believed to have killed somewhere between 25 million and 50 million people, and no other pandemic in the last 100 years has come close to that tally until now. Though a few countries may have endured these past two years with little to no excess deaths, most did not. The U.S., for instance, has long since surpassed over a million excess deaths.
“The majority of the countries in the world have seen substantial increases in mortality,” Msemburi told Gizmodo in an email.
The estimates paint a sobering picture of the world’s pandemic response. There were 4.47 million excess deaths in 2020 and 10.36 million in 2021. The tail end of 2020 saw the release of several COVID-19 vaccines. Many wealthy countries quickly ramped up local vaccination programs, which undoubtedly saved many lives. Just yesterday, for instance, a report from the Commonwealth Fund estimated that the vaccines have prevented over 3 million deaths in the U.S. alone. But widespread access to these vaccines was delayed in many poorer parts of the world. 2021 also saw the arrival and spread of variants of the coronavirus, some of which (especially Delta) caused more severe illness than the original strain or were more transmissible (such as Omicron), even among people with some level of past immunity to the virus. Importantly, though, the vaccines have continued to provide strong protection against the worst outcomes of COVID-19.
“Both the reported COVID-19 mortality and estimated excess have been higher in 2021 than in 2020. In 2021 this is not only due to the more infectious variants but potentially also due to unequal access to vaccines,” Msemburi said.
Msemburi’s team is still working on trying to separate the different patterns of death that occurred during the pandemic. Some causes of deaths in parts of the world have increased for reasons only indirectly related to the pandemic, such as fatal car crashes in the U.S. But these trends haven’t been the same everywhere. Msemburi notes that many other causes of death actually seemed to become less common during the pandemic. This indicates that the excess deaths seen in 2020 and 2021 are largely directly due to COVID-19, and the estimates in many locations might only represent the lower bound of deaths that can be attributed to it. The team also notes that their global estimates may be conservative, at least when compared to those generated by other teams.
This past year has seen fewer reported COVID-19 deaths than the first two years (around a million), with many of these deaths coming off the tail end of the brutal 2021 winter seen in places like the U.S. That should mean fewer excess deaths as well, though the authors are still working on this year’s estimates and don’t want to speculate. Even so, Msemburi says many areas of the world did seem to continue experiencing surges in 2022, “particularly in locations with older populations and low vaccination rates.”
Aside from conveying the full weight of the pandemic, this research should also show that many resource-poor countries lack the mortality and health data needed to better tackle not only global pandemics but other serious health issues, he points out.
“It is crucial that we highlight these data gaps and call for greater investment in civil registration and vital statistics systems. Gaps in information lead to gaps in response, perpetuating unequal access to interventions that could improve the lives of all populations,” he said.