As Governments Move Past COVID-19 They Continue to Undercount Cases and Deaths

The British medical journal, The Lancet, published a report on March 10th providing a systematic analysis of COVID-19 deaths and infections since the outset of the global pandemic. The report states that the actual numbers are an undercount based on analysis of mortality rates in 191 countries and territories, and 252 selected sub-jurisdictions covering 2020 and 2021.

Data from eleven previous years was compared to the last two. On December 31, 2021, the World Health Organization’s (WHO) official count was 5.94 million COVID-19 deaths (it has now surpassed 6 million). The Lancet report noted that the real number was 18.2 million.

The areas where undercounts were most notable included regions of South Asia, North Africa, the Middle East, and Eastern Europe. Countries with the largest undercount included India (see above image of mass cremations in New Delhi), the United States, Russia, Mexico, Brazil, Indonesia and Pakistan. Among the latter, the largest rate of undercounting was ascribed to Russia.

Comparing the Numbers with Influenza and Past Pandemics

If we use the WHO official statistic of 5.94 million deaths by the end of 2021, that amounts to 0.075% of the estimated global population at the end of 2021. If we use the Lancet undercount estimate of 18.2 million, the percentage grows to 0.23%.

For those who claim that COVID-19 is just another flu, comparing the annual death toll from influenza outbreaks should be an eye-opener. The estimated 400,000 annual deaths amount to 0.0052% of the planet’s population.

It’s also meaningful to compare COVID-19 with the Spanish flu outbreak which lasted approximately the same amount of time as our current global pandemic. From 1918 through to the end of 1920, the official mortality statistics amount to 17.4 million deaths. The undercount number based on several recent historical analyses provides estimates of between 24.7 and 100 million. With the world population near 1.8 billion, the low-ball number of 17.4 million equalled 1% of the planet’s population at the time. That rate is 182 times higher than influenza deaths today and 306 times higher than the official COVID-19 mortality count. So with COVID-19, we have done considerably better than the medical science establishment of Spanish flu times.

It took a while for the medical profession to figure out that the Spanish flu, like COVID-19, was spread through the air. Social distancing and mask-wearing were not universally applied. The medical profession and hospitals around the world applied very different protocols with very different results.

A good example of different approaches yielding different results is described in an article appearing in the April 2020 edition of Insider. It summarizes a JAMA-published paper comparing two American cities’ responses to the Spanish flu outbreak at its outset in 1918. The cities were Philadelphia and St. Louis.

In Philadelphia life went on as normal at the beginning. One event at the height of the outbreak, a downtown parade ended up with hospitals filled and 2,600 deaths. In contrast, St. Louis officials closed schools, libraries, courthouses, churches, parks and playgrounds. Limits were placed on the number of people on streetcars. Work shifts were staggered to minimize employee numbers and contact. In the end, Philadelphia’s 1918-19 winter death rates were more than twice that of St. Louis 748  compared to 358 per 100,000 population.

Where We Are with COVID-19 Today

Based on the latest data from Worldometer, official statistics show almost 456 million cases of COVID globally since the outbreak began and the current death count just under 6,060,000. We have seen four different spikes in the outbreak as the virus evolved new variants.

Does the undercount in deaths also indicate an undercount in cases? Apparently. A study published in the journal PLOS One in February of last year concluded that the number of actual COVID-19 cases was between 5 and 20 times higher than official figures.

How could this be? Among the many reasons are these. A number of countries didn’t have the means to gather data on the spread of the virus. Some chose to deliberately lie. And in many areas, poor testing protocols and delays between onset and when testing was done produced many false negatives. In one example the study notes a “severe under-ascertainment” that “was universal across…50 countries with the most confirmed cases and 50 U.S. states.” In 19 of those states alone, the number of cases was estimated to be five times greater than the actual count.

And now as countries and sub-jurisdictions lift mandatory restrictions on public gatherings, and mask usage, in a concerted effort to return to normality, we won’t know what the real numbers are anymore.

Have we achieved herd immunity through vaccination of the global population? Not even close.

Has the uptake of existing vaccines, new vaccines, and new oral medications created a margin of safety? Not yet a certainty.

Will we lose focus as other crises on this planet unfold so that our vigilance against COVID-19 wains? Undoubtedly.