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The global COVID-19 pandemic death toll might be around three times higher than official records, according to researchers.
In a study published Thursday in The Lancet, a group of authors wrote that the estimated number of excess deaths reached over 18 million, or more than three times the 5.94 million deaths the study says were reported for the same period.
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They reached these conclusions with six models used to estimate expected mortality and all-cause mortality reports for 74 countries and territories and 266 subnational locations.
“As mortality records are incomplete worldwide, we built a statistical model that predicted the excess mortality rate for locations and periods where all-cause mortality data were not available,” the authors explained.
Excess mortality was estimated by comparing the total deaths reported from all causes with how many deaths would be expected given recent trends – excluding data from periods affected by late registration and anomalies.
“The highest COVID-19 excess mortality rates were observed in Andean Latin America, eastern Europe and central Europe, with high mortality rates in many high-income northern hemisphere countries and similarly high rates in nearly all of Latin America. Comparatively low excess mortality rates were seen in East Asia, Australia and high-income Asia Pacific. The April–August 2021 surge in south Asia brought cumulative excess mortality rates from the COVID-19 pandemic across that region up to or above the levels that were observed in some high-income countries,” the researchers said. “The cumulative global excess deaths from the pandemic makes COVID-19 potentially one of the leading global causes of death during the period of the pandemic, given the rates and trends in other causes of deaths before the pandemic.”
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Limitations to the study include that different modeling strategies were used, that the most recent weeks and months in 2021 were excluded from the assessment, that they estimated cumulative COVID-19 excess mortality rate, that empirical evidence that most of the excess mortality data is from COVID-19 is absent in most countries, that inclusion of other variables may have improved model predictions, that strict lockdown and mediation interventions can lead to negative excess mortality during the pandemic, that various drivers are responsible for the changes in all-cause and cause-specific mortality in a population, that excess mortality estimates cannot be disaggregated by age or sex and lastly that they expect trends in excess mortality due to COVID-19 to change over time as the coverage of vaccination increases among populations and as new variants emerge.
Understanding the true mortality impact of the pandemic, the authors wrote, is crucial for public health decision-making and future research and increased availability of cause of death data “will be crucial for distinguishing the proportion of excess mortality that was directly caused by SARS-CoV-2 infection.”
According to Nature, the results are the first estimate of global excess deaths to appear in a peer-reviewed journal and the World Health Organization’s (WHO) own analysis is set to be published later in March.
Study co-author Haidong Wang, a demographer and population-health expert at the University of Washington’s Institute for Health Metrics and Evaluation (IHME), told the journal that more work is needed to separate deaths caused by COVID-19 from those that are the indirect results of the pandemic.
While some disputed the study’s numbers, Wang highlighted that different models and techniques will produce different results.
For example, while this model uses 15 variables to estimate a country’s excess deaths, a model from The Economist that also reported “very similar” global excess mortality estimates had a model that uses more than 100 variables.
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The authors spotlighted what they said are “dramatic differences in the estimated excess mortality counts between the two studies for many countries.
According to the Johns Hopkins Coronavirus Resource Center, there have been 6,038,343 COVID-19 deaths reported worldwide since 2020 and 967,165 in the U.S.
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