The lethal impact of the Covid-19 pandemic may be three times greater than official records

On March 11, 2020, the WHO Director-General belatedly announced that the new Covid-19 disease could be characterized as a pandemic. Who would have imagined that two years after the pandemic was “officially” declared, 454 million positive cases and 6 million reported deaths due to SARS-CoV-2 would accumulate. A few days ago, The Lancet published online the first peer-reviewed study to use excess mortality to analyze the lethal impact of the Covid-19 pandemic between 2020–2021 S0140-6736(21)02796-3 and surely no one could have anticipated, that on the same day of the second anniversary we would find out that the number of deaths associated with Covid-19 amounts to 18.2 million, 3 times more than those reported by the countries, according to @IHME_UW estimates. It is striking that to date the WHO has not expressed itself in this regard and the number of total deaths from Covid-19 that this body is estimating is unknown. They may not be very different worldwide, since what was published by @IHME-UW and The Economist newspaper are similar for the same period, with the exception that there are important differences in some countries and that the methodology followed by the newspaper has not been peer-reviewed.

The excess of deaths from a crisis, whether it is a disaster, a pandemic or a war, is a key measure to know the lethal and social impact of the emergency. The registration systems of the countries capture a part, but this procedure, used since the epidemic of a century ago, allows us to see the level of underreporting of the event studied and thus handle figures that are close to reality. Excess deaths are calculated from the difference between the number of recorded deaths from all causes and the number expected based on trends from previous years. Although during the two years of the pandemic there were attempts to estimate the excess deaths related to Covid-19, its geographical scope was limited by the availability of data. This study, according to the authors, is possible thanks to the fact that in two years 74 countries and 266 states or provinces published weekly or monthly data on deaths from all causes and also had them for up to 11 previous years. In addition, 36 countries published individual statistics for all causes of death in 2020. In two years of the pandemic, less than half of the countries in the world generate useful data to know the lethal effect of the pandemic. This is an aspect to improve in future epidemics.

Based on the results, at the country level, the largest number of estimated excess deaths occurred in India (4.1 million), the United States (1.1 million), Russia (1.1 million), Mexico (798,000), Brazil (792,000), Indonesia ( 736,000) and Pakistan (664,000). These seven countries may have accounted for more than half of the global excess deaths caused by the pandemic during the 24-month period. India alone, due to its large population, alone accounted for approximately 22% of the global death toll.

Rates of excess deaths were highest in Bolivia (734.9 deaths per 100,000), Bulgaria (647.3), and Eswatini (634.9); only 21 countries have an excess rate greater than 300 and Mexico, with 325 deaths per 100,000, ranks 20th. It is worth mentioning that by combining states or provinces with countries and organizing them higher according to the rate of excess deaths in 2020 and 2021 (See Table 1) Mexico as a country would occupy the 33rd place, since six states would be within the first 20 places with the highest excess mortality rate in the world, highlighting the CDMX that occupies the fifth place.

The difference between excess mortality and reported Covid-19 deaths could be due to misdiagnosis due to insufficient testing; to notification problems; to higher-than-expected mortality from other diseases due to behavioral changes related to the pandemic or reduced access to health care or other essential services. In contrast, the development and deployment of SARS-CoV-2 vaccines have greatly reduced mortality rates among people who contract the virus and among the general population.

It is possible that this comparison is measuring the response capacity of local health systems and their resilience to the onslaught of the pandemic, which leaves some of them in a very bad position. However, as the authors point out “….The magnitude of the disease burden could have changed for many causes of death during the period of the pandemic due to both the direct effects of the closures and the resulting economic crisis. To correctly divide excess deaths between those due directly to SARS-CoV-2 infection and those associated with changes in other diseases and injuries, it is necessary to consider multiple drivers of change in mortality since the start of the pandemic… ”.

Digital reporting of cause of death data and rapid dissemination of data to the public health community should be sought for this. If more countries invested in timely reporting, we would not only be able to track the effects of this and future pandemics, but we would be able to more quickly assess the effect of behavioral changes, such as social distancing, on death rates from other diseases. and injuries.

The differences shown between reported Covid-19 mortality and Covid-19-related excess mortality highlight the importance of using excess mortality estimates in policy and in monitoring and evaluation efforts. But above all, they acknowledge that by strengthening death reporting systems and mitigating political barriers to accurate reporting, it will be possible to better track and monitor the continuation of the existing Covid-19 pandemic and future pandemics.

*The author is a professor at the University of Washington in the Department of Health Measurement Sciences and the Institute for Health Metrics and Evaluation and co-author of the article analyzed.

Twitter: @DrRafaelLozano

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