The World Health Organization is estimating that nearly 15 million people were killed either by the coronavirus or by its impact on overwhelmed health systems in the past two years, more than double the official death toll of six million. Most of the fatalities were in Southeast Asia, Europe and the Americas.
In a report released on Thursday, WHO chief Tedros Adhanom Ghebreyesus described the figure as "sobering," saying it should prompt countries to invest more in their capacities to quell future health emergencies.
Scientists tasked by WHO with calculating the actual number of COVID-19 deaths between January 2020 and the end of last year estimated there were between 13.3 million and 16.6 million deaths that were either caused directly by the coronavirus or were somehow attributed to the pandemic's impact on health systems, like people with cancer unable to seek treatment when hospitals were full of patients with the virus.
The figures are based on country-reported data and statistical modelling.
"This may seem like just a bean-counting exercise, but having these WHO numbers is so critical to understanding how we should combat future pandemics and continue to respond to this one," said Albert Ko, an infectious diseases specialist at the Yale School of Public Health who was not linked to the WHO research.
For example, Ko said, South Korea's decision to invest heavily in public health after it suffered a severe outbreak of MERS allowed it to escape COVID-19 with a per-capita death rate around 1/20th of that of the U.S.
Middle-income countries struggled to report: WHO
Nearly one-third of the excess total was estimated to be in India, at 4.7 million. The country, which suffered a devastating wave spurred by the Delta variant in 2021, had said at the end of that year its COVID-19 deaths stood at 481,080 people.
India's case count matched a general trend in the data, which saw 68 per cent of the excess death toll concentrated in 10 highly populated, middle-income countries, a list that includes Pakistan, Nigeria, Indonesia and Mexico.
Countries in Europe and North America where modelling suggests that official death tolls are an undercount include the United States, Great Britain, Italy, Germany, Poland and Ukraine.
Other countries that ranked high on the excess death modelling included Brazil, Colombia, Iran, Philippines, Peru, Russia and South Africa.
WHO officials noted a significant disparity by gender, with men accounting for 57 per cent of the estimated deaths, while older adults were disproportionately affected compared to the share of population.
Excess Canadian deaths across age groups in 2021
Statistics Canada has previously estimated there were 16,333 more deaths in the country by the end of 2020 than otherwise would be expected before the pandemic. Last month, the statistics agency estimated excess deaths between the beginning of the pandemic in March 2020 through to the end of November 2021 at 28,987 people.
The WHO data does not appear to deviate greatly from those figures but provides context on the evolution of the virus over time. In 2020, 57.3 per cent of the excess deaths were estimated to be in those 80 and over, although the 25-39 demographic saw deaths nearly 11 per cent above what might have been expected in the absence of the pandemic. Nearly 70 per cent of the excess deaths were of men.
But in 2021, when vaccinations were readily available, the dramatic age skew is not seen. The 70-79, 60-69 and 25-39 cohorts all saw excess deaths more than 20 per cent greater than would be expected, while the excess deaths of those between 40 to 59 was estimated to be about 15 per cent greater.
The Canadian Medical Association and others have indicated that postponed surgeries, delayed emergency room visits and a toxic street drug supply during the pandemic have contributed to excess death.
Accurate numbers on COVID-19 deaths have been problematic throughout the pandemic, as the figures are only a fraction of the devastation wrought by the virus, largely because of limited testing and differences in how countries count COVID-19 deaths. According to government figures reported to WHO and to a separate count kept by Johns Hopkins University in Baltimore, there have been more than six million reported coronavirus deaths to date.
Dozens of countries don't document cause of death
As well, WHO officials said Thursday, about 70 countries don't regularly produce cause of death certificates, a figure Dr. Stephen MacFeely, WHO's director of data and analytics, called "shocking."
Scientists at the Institute of Health Metrics and Evaluation at the University of Washington guessed there were more than 18 million COVID-19 deaths from January 2020 to December 2021 in a recent study published in the journal Lancet, and a team led by Canadian researchers estimated there were more than three million uncounted coronavirus deaths in India alone.
Some countries, including India, have disputed WHO's methodology for calculating COVID-19 deaths, resisting the idea that there were many more deaths than officially counted. Earlier this week, the Indian government released new figures showing there were 474,806 more deaths in 2020 compared to the previous year, but did not say how many were tied to the pandemic. India did not release any death estimates for 2021.
Yale's Ko said better figures from WHO might also explain some lingering mysteries about the pandemic, like why Africa appears to have been one of the least affected by the virus, despite its low vaccination rates. "Were the mortality rates so low because we couldn't count the deaths or was there some other factor to explain that?" he said.
Dr. Bharat Pankhania, a public health specialist at Britain's University of Exeter, said we may never get close to the true toll of COVID-19, particularly in poor countries.
"When you have a massive outbreak where people are dying in the streets because of a lack of oxygen, bodies were abandoned or people had to be cremated quickly because of cultural beliefs, we end up never knowing just how many people died," he said.
Pankhania warned the cost of COVID-19 could be far more damaging in the long term, given the increasing burden of long COVID.
"We do not know the extent to which people with long COVID will have their lives cut short and if they will have repeated infections that will cause them even more problems."
