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Global COVID-19 deaths could actually be double

According to a report recently released by the University of Washington’s Institute for Health Metrics and Evaluation (IHME), direct COVID-19 deaths may be more than double previous estimates. 

Many deaths from COVID-19 go unreported because countries only report deaths that occur in hospitals or patients with a confirmed infection. In many places, weak health reporting systems and low access to health care significantly increase this challenge.

The investigators reported that by May 3, global COVID-19 deaths numbered 6.93 million, compared with the reported 3.24 million. They also calculate that the cumulative total COVID-19 death rate was 89.5 per 100,000 patients, going from 0.1 per 100,000 in Vietnam to more than 400 per 100,000 in 12 countries, led by Azerbaijan, Bosnia, and Herzegovina, and Bulgaria.

IHME estimated total COVID-19 deaths by comparing anticipated deaths from all causes based on pre-pandemic trends with the actual number of all-cause deaths during the pandemic. 

This “excess mortality” figure was then adjusted to remove deaths indirectly attributable to the pandemic (for example, due to people with non-COVID conditions avoiding health care facilities) as well as deaths averted by the pandemic (for example, declines in traffic deaths due to lower mobility). 

The resulting adjusted estimates include only deaths directly due to the SARS-CoV-2 virus, which causes COVID-19. A detailed write-up on methodology is available on IHME’s website. IHME researchers concluded that 56 countries and 198 subnational units had sufficient data and that supplementary publications added 12 more national or subnational locations.

The ratio of total-to-reported deaths is high in many Eastern European and Central Asian countries, according to the researchers. In sub-Saharan Africa, which has reported lower COVID-19 deaths, the data indicate ratios are between 1.6 to 4.1; in India, which is currently being ravaged, the ratio is 2.96. High-income countries tended to have lower ratios. 

The new data change the top five countries in COVID deaths, with Russia (109,334 reported; 593,610 total) surpassing the United Kingdom (150,519 reported; 209,661 total) and Italy (121,257 reported; 175,832 total). The United States has the most deaths, with 905,289 (574,043 reported), followed by India with 654,395 (221,181 reported), Mexico with 612,127 (217,694 reported), Brazil with 595,903 (with 408,680 reported), and then Russia.


Dr. Melvin Sanicas (@Vaccinologist) is a physician-scientist specializing in vaccines, infectious diseases, and global health.

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