How the Covid Death Toll Is Even Worse Than It Looks

There has been chronic undercounting of Covid deaths due to the way many government entities categorize them. 

In particular, co-morbidities triggered by the virus are frequently not labelled Covid deaths. But the figures on 'excess' or above normal death tolls in most areas can be explained by the pandemic. JL

Paul Overberg and colleagues report in the Wall Street Journal:

More than 2.8 million people have lost their lives due to the pandemic, according to a Wall Street Journal analysis of data from 59 countries and jurisdictions. This tally offers the most comprehensive view yet of the pandemic’s global impact. Deaths in these places last year surged more than 12% above average levels. Less than two-thirds of that surge has been attributed directly to Covid-19. Public-health experts believe that many of the additional deaths were directly linked to the disease, particularly early in the pandemic. Some of those excess deaths came from people avoiding the hospital and other issues.

The recorded death count from the Covid-19 pandemic as of Thursday is nearing 2 million. The true extent is far worse.

More than 2.8 million people have lost their lives due to the pandemic, according to a Wall Street Journal analysis of data from 59 countries and jurisdictions. This tally offers the most comprehensive view yet of the pandemic’s global impact. Deaths in these places last year surged more than 12% above average levels.

Less than two-thirds of that surge has been attributed directly to Covid-19. Public-health experts believe that many, if not most, of the additional deaths were directly linked to the disease, particularly early in the pandemic when testing was sparse. Some of those excess deaths came from indirect fallout, from health-care disruptions, people avoiding the hospital and other issues.

To better understand the pandemic’s global toll, the Journal compiled the most recent available data on deaths from all causes from countries with available records. These countries together account for roughly one-quarter of the world’s population but about three-quarters of all reported deaths from Covid-19 through late last year.

The tally found more than 821,000 additional deaths that aren’t accounted for in governments’ official Covid-19 death counts.

Only about one in four countries world-wide track deaths on a running basis—and few of those have data more recent than November. The countries in the Journal’s tally would likely have counted about 15 million deaths through late fall without the pandemic, based on prior-year trends. Instead, they reported nearly 17 million deaths through that time period. The difference equals roughly the population of Nebraska.

Tracking all of these deaths, and doing it quickly, is vital to help understand the breadth of the crisis, public-health experts say.

“Measuring total deaths gives you a readout if things are getting better or worse,” said Colin Mathers, a retired coordinator of the World Health Organization’s Mortality and Health Analysis Unit. “If you see a sudden rise in heart disease, it may be linked to Covid-19, but if there’s a rise in cancer it may be because of people fearing to go to the hospital.”

Some countries, including New Zealand and Norway, are actually showing lower-than-expected deaths. This may be the effect of controlling the virus through behavior changes that tamp down other causes of death, such as increased hygiene and reduced social interactions that spread other diseases, researchers say.

Overall, the toll from the countries analyzed by the Journal shows a staggering human loss, even before accounting for all deaths from the late-year surge in Covid-19 cases.

Because vital statistics can miss connections between deaths and major events, epidemiologists often measure excess deaths—or death tolls above expected levels—to try to capture the fuller picture.

The Journal used the same simple method to calculate expected deaths by averaging death tolls for each country in recent years, then measuring the differences. Tallies for some countries may differ from those nations’ own calculations.

Studying excess deaths helped researchers link a heat wave in France to roughly 15,000 deaths in 2003, and nearly 3,000 fatalities to Hurricane Maria in Puerto Rico in 2017, far above the island government’s original count of 64. Examining excess deaths helps incorporate those who perished over a longer period of time due to issues such as health-care disruptions and power outages.

The United Nations had projected that absent the pandemic, there would have been roughly 59.2 million deaths last year. It’s too early to say by how much the planet exceeded that. The pandemic may have accelerated the deaths of some people who still would have died in 2020. Still, researchers who examined the impact early in the pandemic found even the oldest victims were losing almost a year of life on average.

In the U.S. alone, Centers for Disease Control and Prevention data show more than 475,000 excess deaths through early December, a time frame that also included about 281,000 deaths linked to Covid-19, according to Johns Hopkins University.The pandemic led U.S. deaths to climb at least 10% last year. Typically U.S. deaths grow about 1.6% a year as the population grows and ages.

Covid-19 has already taken third place on the list of top causes of death, after heart disease and cancer.

Prabhat Jha, who directs the Centre for Global Health Research, a nonprofit sponsored by the University of Toronto and St. Michael’s Hospital in Toronto, said future data and analysis will likely show most U.S. excess deaths are linked directly to Covid-19.

Testing shortages made it harder to catch the disease early in the pandemic, and some Covid-19 deaths may have been blamed on the flu and pneumonia instead, said Robert Anderson, chief of the mortality-statistics branch at the CDC’s National Center for Health Statistics.

The U.S. has seen other problems. Cerebrovascular diseases like strokes are up too, as are deaths from diabetes and high blood pressure; doctors say people avoiding hospitals and rationing medicine likely had an effect. A spike in deaths among patients with Alzheimer’s disease and dementia has been particularly acute, highlighting the risk of nursing home lockdowns on already fragile residents.

“There may be people dying for other reasons other than the virus, particularly in a situation where they are isolated for a length of time, they may not have access to care, they may be afraid to seek care,” Mr. Anderson said.

In the U.S., the virus has disproportionately hit minority groups. Issues like underlying health conditions, poorer access to health coverage and care, more crowded living conditions and virus exposure from front-line jobs have all contributed to higher death tolls for minorities.

This uneven impact is showing up, too, in excess deaths that haven’t been linked to Covid-19.Excess death surges have struck around the U.S. at different times, tracking the intensity of Covid-19 outbreaks in different regions, CDC data show.The makeup of excess deaths may wind up looking different around the world. France and Spain both reported roughly similar Covid-19 death rates through early December. Yet in France, all excess deaths through that point were officially linked to Covid-19, while in Spain, only two-thirds were. European mortality experts say Madrid didn’t track Covid-19 deaths as assiduously as Paris did, including at nursing homes.

The excess-death toll will continue to grow as data emerges from many developing nations where compiling death statistics is a slower and more arduous task, such as India and Indonesia. Epidemiologists often rely on measures of population samples, or surveys conducted by visiting towns and villages to ask questions about who has died, to help build a fuller picture.

In Iran, which has been hit hard by the coronavirus, government officials have said total fatalities could be triple the official Covid-19 death toll, which was recently about 56,000. In Afghanistan, locals believe the actual death toll is many times the official figure of roughly 2,300 Covid-19 deaths.

Many countries, including Vietnam, Thailand and Costa Rica, plan to offer full-year figures later this year, and China could release data as soon as Monday.

The Journal’s tally didn’t include many countries in Africa, where the pandemic death toll remains largely unknown. South Africa, which tracks deaths weekly, has reported more than 22,000 Covid-19 deaths but more than twice that number of excess deaths. Many other countries say they have fared better, based on local reports from hospitals and cemeteries across the continent. Several countries have refused to publish data on coronavirus deaths, and in others, limited statistics cloud the virus’s toll. Early figures from the continent’s emerging second wave suggest the number of coronavirus deaths this year could rise significantly.

Other parts of the world that have yet to report data on all 2020 deaths may not move the needle much. China, where the virus first emerged, and with a population of roughly 1.4 billion, has officially recorded fewer than 5,000 Covid-19 deaths, according to Johns Hopkins. The most populous country’s coming 2020 mortality report will add a major piece to a still-incomplete global puzzle.

Meanwhile, the death toll marches on. Since the most recent total death reports, the countries analyzed by the Journal have collectively recorded more than 444,000 additional Covid-19 deaths stretching into early 2021. In Europe, Germany’s known Covid-19 death toll has climbed to 43,881 from about 16,200 in late November, when total death numbers were available. Greece’s known virus deaths surged to 5,354 from 626 since late October.

“The last word won’t be known for a couple of years, when the full analysis of all causes of death is complete,” said Mr. Mather, the retired WHO official

Methodology: To analyze the pandemic’s toll, the Journal compiled weekly or monthly death data for 2020 and for 2015-19, where available. Most of the data was collected from national statistical agencies, either directly or indirectly through inter-governmental or academic groups. In a handful of nations, data was collected by health data organizations or local analysts. Epidemiologists use several methods to calculate excess deaths, adjusting for age composition, incomplete data and other factors. The Journal used a straightforward method, summing deaths for the portion of 2020 available and subtracting from that total the average number of deaths that occurred in the same span of each year from 2015-19. When the result falls below zero—when the 2020 death total fell below the average—some countries adjust the result to zero, boosting excess death totals. The Journal did not adjust in those cases. All totals are based on actual counts and comparisons. For some nations, the average was based on three or four recent years, typically 2016-19.