Global Covid death toll could be as high as 18 million – three times higher than previously thought

Around 18.2 million people may have died worldwide because of the Covid pandemic, according to new estimates that suggest the global scale of mortality during the past two years has been vastly understated.

This figure is more than three times higher than the official death toll for Covid: between 1 January 2020 and 31 December 2021, a total 5.9 million fatalities were reported by governments across the world.

The new study, published in The Lancet, suggests the disparity in figures may be a result of poor testing regimes in countries, issues with reporting causes of death and, in some nations, deliberate under-counting of fatalities.

It also argues that excess deaths – the difference between the number of recorded deaths from all causes and the number expected based on past trends – are a key measure of the true death toll of the pandemic.

Distinguishing between deaths caused directly by Covid-19 and those that occurred as an indirect result of the pandemic is crucial, helping to provide a better picture of the past two years, authors say.

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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 healthcare and other essential services during the pandemic.

The impact of these various factors will vary by country and region, the authors add.

The research indicates that the UK’s death toll could be both higher or lower than what official records show. Some 173,000 fatalities have been reported to date, whereas the study estimates between 163,000 and 174,000 people have died during the pandemic.

According to the study, India suffered the highest number of excess deaths, estimated at 4.1 million, followed by the US and Russia, with 1.1 million each.

Co-author Dr Haidong Wang, of the Institute for Health Metrics and Evaluation (IHME), America, said: “Understanding the true death toll from the pandemic is vital for effective public health decision-making.

“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.

“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.”

Chris Murray, co-author of the paper and a director at the IHME, said 80 to 90 per cent of the excess deaths were likely to be from Covid itself.

Researchers collected weekly or monthly data on deaths from all causes in 2021, 2020, and up to 11 previous years for 74 countries and 266 states and provinces through searches of government websites, the World Mortality Database, Human Mortality Database, and European Statistical Office.

The data were used in models to estimate excess deaths due to the pandemic, including for locations with no weekly or monthly reporting of death data.

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.

According to the research, rates of excess death are estimated to have varied significantly by country and region.

The highest estimated excess deaths were in:

Outside these regions several locations are estimated to have had similarly high rates, including Lebanon, Armenia, Tunisia, Libya, several regions in Italy, and several states in the American South.

South Asia had the highest number of estimated excess deaths from Covid, with 5.3 million excess deaths, followed by North Africa and the Middle East (1.7 million), and Eastern Europe (1.4 million).

Along with the US and Russia, Mexico (798,000), Brazil (792,000), Indonesia (736,000), and Pakistan (664,000) may have all accounted for more than half of global excess deaths caused by the pandemic over the 24-month period, the study suggests.

The authors acknowledged a number of limitations to their study. A statistical model was used to predict excess deaths for countries that did not report weekly or monthly data on deaths from all causes, highlighting the need for direct measurements from these locations.

Excess death estimates were calculated for the full study period only, and not by week or month, due to lags and inconsistencies in reporting of Covid-19 death data that could drastically alter estimates.