As the US approaches the grim milestone of one million COVID-19 deaths, a team of researchers published the first peer-reviewed study looking at excess death estimates on a global scale. The results are alarming, health experts say.
Excess deaths is the difference between the number of recorded deaths from all causes and the number of expected deaths based on past trends.
Researchers at the University of Washington’s Institute of Health Metrics and Evaluation found an estimated 18.2 million people may have died by the end of 2021 due to the COVID-19 pandemic, more than three times the official toll of 5.9 million, according to the study published Thursday in The Lancet.
“I’ve never seen an analysis of this scale before on excess mortality,” said Dr. Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University in Richmond, who is unaffiliated with the study. “The findings are very sobering.”
The IHME team obtained weekly or monthly data on deaths from 74 countries and 266 states or provinces using government websites from 2020 to 2021, and compared that with death data going back 11 years.
South Asia had the highest number of estimated excess deaths from COVID-19 at about 5.3 million, followed by North Africa and the Middle East, both at 1.7 million. Eastern Europe had about 1.4 million excess deaths from COVID-19, the study found.
“Understanding the true death toll from the pandemic is vital for effective public health decision-making,” said lead author Dr. Haidong Wang, an associate professor at the University of Washington.
The seven countries with the highest number of excess deaths accounted for more than half of the estimated global toll and included India, the US, Russia, Mexico, Brazil, Indonesia and Pakistan.
Although the US has yet to officially record one million COVID-19 deaths, the IHME study estimated the nation may already have reached 1.1 million by the end of 2021.
Some countries were estimated to have had fewer deaths than expected based on mortality trends in prior years, including Iceland, Australia and Singapore.
“There are a number of places that end up looking like they’ve done well,” said senior author and IHME director Dr. Chris Murray. “And if you look region by region, there are neighboring countries that are very different so, it speaks to how countries have managed the pandemic.”
Countries that had fewer to no excess deaths followed a pandemic strategy in 2020 that included hard lockdowns, mask mandates and aggressive testing, experts say.
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When vaccines were rolled out, these same countries launched rigorous vaccination campaigns that removed obstacles to get the shot, while increasing barriers for those who were unvaccinated. In the wealthy city-state of Singapore, more than 92% of the total population is fully vaccinated, according to Our World in Data.
Countries that experienced few excess deaths also reimposed lockdowns and mask mandates when transmission increased, Woolf said, and the public complied.
“They were very organized, they were comprehensive and they functioned as a cohesive national government,” he said. “Most of those steps did not happen in the US, and the excess death rate that we experienced shows that.”
Murray says the study’s findings are the best estimates to date, but he acknowledges the need for more data.
Only 36 countries released a cause of death in their weekly or monthly data; some countries did not release mortality data at all. Researchers used a statistical model to calculate excess deaths in these countries, the majority in sub-Saharan Africa.
“We currently don’t have enough evidence for most locations,” Wang 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.”
The availability of data may strengthen the study’s findings, Woolf said, but the takeaway message remains the same.
“The actual numbers don’t matter as much as the main point… The number of people who died from this pandemic is larger than we think,” he said. “These policy choices have consequences.”
Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.
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George is Digismak’s reported cum editor with 13 years of experience in Journalism