New Analysis Finds COVID-19 Death Toll Is Substantially Higher Than Reported
A comprehensive study from the Institute for Health Metrics and Evaluation (IHME) found that the worst pandemic in 100 years is twice as deadly as we’ve been told.
Official COVID-19 death counts are problematic for a lot of reasons. At the top of this list is the fact that many lower income countries don’t have the necessary testing capacity to determine if the deceased carried the virus. WHO testing guidelines call for costly equipment like RNA extraction kits and real time PCR machines, as well as trained staff to use them. However, countries like Nepal had only 1 adequate testing facility at the beginning of the pandemic to service nearly 30 million people. This means Nepal’s 4,466 deaths (at the time of writing) is likely much higher.
The story is the same for other developing nations, as Catharina Boehme, chief executive officer of the Foundation for Innovative New Diagnostics (FIND), a global nonprofit organization based in Geneva, says “We get desperate calls from laboratories, from governments every day, about supply challenges.” African nations have had a particularly difficult time procuring much needed tested supplies, again meaning COVID-19 deaths have gone undetected.
Reporting has also been a big problem, especially with older demographics. For example, in the US, the COVID Tracking Project, a team of researchers under The Atlantic’s umbrella, determined that pandemic related deaths among elderly patients in nursing homes and long-term care facilities are drastically underreported. They say this is because the data “covers only skilled nursing facilities, and excludes the experience of approximately 800,000 people living in assisted living facilities and similar residential care communities.” They believe the problem stems largely from a lack of federal and state reporting requirements and inadequate testing of the deceased, particularly in the first few months of the pandemic.
In India, before the pandemic, only 86% of the dead were counted—only 22% were given an official cause of death. This is due to the country’s poor health infrastructure, as many do not have access to hospitals, clinics, or any other care facilities, leaving them to die at home, outside the reach of those that could test and record the reason for their death. When COVID-19 hit India, medical facilities were quickly overwhelmed, making the actual number of victims far greater than reported, with one estimate putting it 5 times higher. Making the situation worse is that enforcing reporting requirements has proven difficult across such a populated and diverse country. The head of India’s National Centre for Disease Informatics and Research said that “it was difficult to ensure individual states followed the guidelines to capture all confirmed and suspected Covid deaths.”
Furthermore, official COVID-19 death tallies might be politically influenced. In December 2020, Tatiana Golikova, Russia’s deputy prime minister, admitted that his country had been fudging the the COVID-19 death numbers. After intense scrutiny due to its implausibility, the official death count of 57,000 was changed to 180,000 because the “deputy prime minister’s admission will embarrass President Vladimir Putin, who has favourably compared Russia’s response to those of other countries, on the basis of its supposed low death rate.” A similar story unfolded in October 2020, when Ruy López Ridaura, the director of Mexico’s National Centre for Preventive Programs and Disease Control, admitted to the press that 50,000 COVID-19 deaths had been intentionally omitted from official records.
In Florida, COVID-19 death data is a mess. Governor Ron DeSantis has been criticized for forcing the state’s health department to manipulate the data to downplay the impact of the pandemic and allow the state to relax lockdown orders. A lot of this has been dismissed as political noise, but authors of a study published in the American Journal of Public Health analyzed Florida’s data and found that “The impact of COVID-19 on mortality is significantly greater than the official COVID-19 data suggest.”
Given all of the above, it seems official COVID-19 death data is severely underreported. So how do we get a more accurate estimate? The answer is excess mortality rates.
Excess Mortality Rates
Excess mortality is a concept used by epidemiologists and other public health experts to determine the severity of a health crisis by looking at the number of deaths above the historical average for a given time period. For example, let’s say over the last 20 years it’s been common for around 100 people per week to die in a given city. Some years it’s a little more, and some years it’s a little less, depending on the myriad of factors contributing to the death rate. Overall, the graph remains relatively flat. However, if the deaths per week jumps from 100 to 250, then it’s reasonable to assume that something out of the ordinary, like a global pandemic, is happening.
When it comes to COVID-19, excess mortality rates have been a great source of information for health experts. In the graph below, non-pandemic years can be seen at the bottom, where they more or less follow the same pattern. The years 2020 (red) and 2021 (purple) clearly standout, as does the impact from important events like the roll out of the vaccines in early 2021.
However, there’s a problem. Graphs like this one don’t tell the whole story, as they only incorporate the raw death data. That is, if we’re trying to determine the real COVID-19 death rate, we need to understand the reasons for such a large jump in data. For example, if someone has a heart attack, is unable to get care because of an overwhelmed health care system, and dies, then his or her death would contribute to the excess mortality rate, though he or she didn’t actually die of COVID.
Fortunately, researchers from the IHME did a comprehensive analysis of excess mortality rates, country by country. They relied on six pandemic-related factors:
- Increase in deaths from delayed or deferred health care
- Increase in deaths from mental health disorders, such as depression and increased substance abuse
- Increase in deaths from actual COVID-19 infection
- Decrease in deaths from less fatal injuries because of lockdown orders and social distancing
- Decrease in deaths from less transmission of other viruses, namely the flu, because of prevention measures
- Decrease in deaths from other medical problems that would’ve caused a death before the pandemic
The researchers claimed that “To correctly estimate the total COVID-19 mortality, we need to take into account all six of these drivers of change in mortality that have happened since the onset of the pandemic.”
After painstakingly sifting through each country’s data, they produced a far more accurate estimate for COVID-19 deaths. On the right is the data for 20 countries that showed the biggest disparity between what was reported and the new estimate. Some of the results are staggering. Egypt’s death count multiplied by 12, Kazakhstan by nearly 15.
Overall, with this new approach, the global death rate for COVID-19 is 6.9 million (as of May 2021), more than double the official count.
Final Thoughts
With this new data, perhaps people will make more of an effort to stop the spread of the COVID-19 pandemic by getting vaccinated, social distancing, wearing a mask, etc. Though in the US, 1 in 4 adults refuse to get the vaccine, due to a misunderstanding of fundamental science and conspiracy theories, making herd immunity unlikely. Many other countries show similarly disappointing data, as shown in the chart below.
On a positive note, the percentage of those unwilling to get the vaccine continues to drop, perhaps due to them witnessing the increasing devastation of the pandemic. If the trend continues, we might have a chance of containing and eradicating the virus. On a more realistic note, COVID-19 is likely going to end the same way the Spanish Flu did from 1918 to 1920: just peter out. According to J. Alexander Navarro, a medical historian, “The end of the pandemic occurred because the virus circulated around the globe, infecting enough people that the world population no longer had enough susceptible people in order for the strain to become a pandemic once again.”
In other words, the virus weeded out the vulnerable because we were unable or unwilling to protect them. I’d like to think we’ve progressed in the last 100 years, but we’ll see in the next few years by how much, if any.
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