World Health Organization Acknowledges Undercounting of COVID-19 Deaths

The official number of COVID-19-caused deaths as reported by countries across the globe has eerily settled on the number 6 million. That’s the same number associated with the murder of Jews by Hitler’s Third Reich in World War Two. It is a number slightly less than the 6.4 million people that live in the Greater Toronto Area. Imagine the sudden disappearance of that number of people. It boggles the mind.

But now consider what the World Health Organization (WHO) is telling us is the real number, nearly 21 million based on adding excess death counts. That’s close to 15 million more than official reports; 4 million more than all the people of The Netherlands; equivalent to the population of Sri Lanka, or all the people living in Austria, Switzerland and Croatia combined.

And it has all happened because of a virus that caught the world unprepared.

The WHO report released today states that total deaths as reported by national health authorities attributable to COVID-19 don’t take into account excess mortality, or as it describes, “the mortality above what would be expected based on the non-crisis mortality rate.” 

Excess mortality is not a measure that can easily be gleaned from across the planet. Why not? Because not all countries measure mortality at the same pace and in the same way. Data reporting techniques differ. Some countries don’t even measure at all. This makes calculating excess mortality problematic.

Within regions, there are accuracy challenges. The WHO collects data from Africa, The Americas, The Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific. Often data is withheld such as in Russia, China, North Korea, and recently, Tanzania.

All countries are asked to supply official COVID-19 death counts. The WHO and others compare these numbers with normal death counts. To determine excess mortality, the WHO looks at increases over and above the norm to come up with a COVID-19 estimate. And that’s the number this latest WHO report shared today, coming in at just under 15 million.

How accurate is the 15 million number?

The WHO are not on their modelling COVID-19 statistics. Others dispute the WHO’s numbers. For example, The Economist, the British news magazine using data from John Hopkins University, and an artificial intelligence machine-learning algorithm, recently estimated excess death numbers at 21 million (see graph at the top of this posting), which means total COVID-19 deaths have surpassed 27 million. That’s almost the population of Belgium and The Netherlands combined.

But let’s stick with the 15 million excess for now and what makes up the variables that produced the number. The WHO calls these data variables covariates and attributes them to several factors such as war, climate change, extreme weather events, famine and food scarcity, vector-borne and systemic disease, age, and sex. Most covariates remain constant over time, and so can be ruled out when looking at excess mortality.

Then there is the way death statistics get reported from different countries. Some countries have tracked COVID-19 differently. Some report monthly death rates and some provide no data at all as in the case of the government of Tanzania, which in 2021, stopped reporting COVID-19 deaths because the leader of the country was in denial. The same is true for North Korea which has denied the disease has ever breached its borders. Fortunately, these two are more the exception than the rule.

The modelling the WHO is using has tried to look at how age and sex determine excess mortality attributable to COVID-19. Here too there are variables among nations. Countries that have provided criteria-specific age and sex data show that age matters more than sexual identity. And because there is enough information on these covariates from those countries that do provide this type of detail, the WHO can estimate numbers from countries not reporting on these specific data points. In summary, whereas there is little to differentiate excess death rates based on sex, there is an 18 times more likely rate of excess mortality among people 70-years or older.

The definition of what is a COVID-19-related death is also included in WHO calculations. These include deaths directly attributable to the virus, deaths from medical conditions complicated by it, and cases where the presence of COVID-19 in the general population delayed or stopped treatment of other medical conditions or illnesses leading to death.

In a New York Times article published today, Dr. Prabhat Jha, an epidemiologist at St. Michael’s Hospital here in Toronto expressed concern about the data and our ability to understand what the world has been going through these last two years. He states, “It’s absolutely staggering what has happened with this pandemic, including our inability to accurately monitor it…It shouldn’t happen in the 21st century.” Dr. Jha was one of the WHO experts calculating the excess mortality associated with the virus.

Looking at the Numbers

What the WHO data shows, as do other excess death rate studies, is that the majority of deaths from COVID-19 occurred in 2021: 10 million of the 15 million in total. Of those 4.7 million happened in India compared to the 481,080 deaths reported; 1.1 million in Russia compared to 310,000, and more than one million over official totals in Indonesia. In the United States, excess death totals were more than double the reported deaths at 820,000 making the actual COVID-19 number 1.75 million by the end of 2021.

The Times article mentions that numbers the WHO has determined are seen by other reporting organizations to be more conservative. It cites reports released by The Economist and Institute for Health Metrics and Evaluation for comparison.

Why is knowing the actual death count from COVID-19 so important? It is not because of a maudlin interest in the impact the virus has had on humanity and the planet. Dr. Samira Asma, Assistant Director-General for Data and Analytics, at the WHO gives a good rationale in the New York Times article. He states “When we underestimate, we may underinvest, and when we undercount, we may miss targeting the interventions where they are needed most.”

What Dr. Asma doesn’t say is that in a world where climate change and our encroachment on nature make us more susceptible to new viruses, more reliable and timely reporting of real-world data is vital to avoid a future outbreak. We don’t need another global pandemic causing 21 million unneeded deaths.