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The coronavirus might not be the worst of it
The Washington PostDemocracy Dies in Darkness

Opinion The pandemic toll may be three times greater than reported. That’s a lot of lost souls.

The White House is seen Sept. 24, 2021, amid a section of “In America: Remember,” an art installation on the National Mall that features flags representing every death from covid-19 in the United States. (Craig Hudson for The Washington Post)
Comment

The pandemic was worse than the official numbers show, and how much worse is now becoming more evident after two years. A new study, based in part on statistical modeling, suggests the loss in lives was close to three times greater than the official data. It is important to understand what happened and why in the greatest public health catastrophe since the 1918 influenza pandemic, which is estimated to have killed at least 50 million people.

The new study, peer-reviewed, was published Thursday in the Lancet medical journal and carried out at the Institute for Health Metrics and Evaluation at the University of Washington. The research, examining the pandemic years 2020 and 2021, found that while the official death toll worldwide was 5.94 million due to covid-19, in fact 18.2 million people might have perished in the pandemic. That estimate is similar to one reached by the Economist in ongoing research that uses different methods. Both studies suggest that the pandemic’s pain in lost lives has been undercounted because of a combination of factors, including neglected treatment for other ailments.

At the core of this is a measure of excess mortality, the difference between the observed numbers of deaths from all causes, and what would normally be expected over the same time period, absent the pandemic. Although excess mortality is an estimate, it can help underscore the true scope of the catastrophe in lost lives, help scientists prepare for the next pandemic and pinpoint vulnerabilities in public health systems.

The official covid death toll undercounts for several reasons. Health-care systems often don’t list covid as a cause of death without a positive test — so, many who died were not counted as covid because they lacked a test. According to the study, before tests were widely available, “many deaths due to COVID-19 among older individuals in high-income countries, particularly in long-term care facilities,” were not counted as covid. Moreover, nearly 4 in 10 of the world’s deaths are unregistered, according to the World Health Organization; in Africa, only 10 percent of deaths are registered, compared to 98 percent in Europe and 91 percent in the Americas. On top of this, covid so flooded health-care systems that many people who suffered other sicknesses could not get treatment and died. They might have survived were it not for the pandemic. Taken all together, the new study declares, pandemic mortality “has been more devastating than the situation documented by official statistics.”

Excess mortality differed around the world. In the United States, the researchers said the two-year official death toll was 824,000 but the estimated excess deaths were 1.1 million. Undoubtedly, those estimates are higher today after the omicron surge. The official U.S. covid death rate was 130.6 per 100,000 population, but the estimated excess-mortality rate was 179.3 per 100,000.

Globally, the researchers say that a “substantial fraction” of the 12 million deaths beyond the official counts were probably caused by covid, just not properly accounted for. Figuring out why should help everyone grasp the true size of this disaster.

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