• Covid-19 18 months dying too many: the excess of deceased since the summer of 2020 already exceeds by 20% that of the worst months of the pandemic

Two years after the World Health Organization (WHO) declared the global outbreak of Covid-19 a pandemic,

The Lancet

has published a study that points to the possibility that

three times as many people worldwide have died as a result of COVID-19.

the infection of what the official records of deaths from Covid-19 suggest.

Thus, while the

official number of deaths from Covid was 5.9 million between January 1, 2020 and December 31, 2021, the new study calculates that there were 18.2 million

deaths during the same period, suggesting that the full impact of the pandemic may have been much greater.

Excess deaths - the difference between the number of recorded deaths from all causes and the number expected based on past trends - is a key measure of the true number of deaths from the pandemic.

Although there have been several attempts to estimate excess mortality from Covid, most have been limited in geographic scope by data availability.

The new study provides the first peer-reviewed estimates of excess deaths attributed to the pandemic globally, for 191 countries and territories (and 252 subnational places such as states and provinces) between January 1, 2020, and December 31, 2020. 2021.


weekly or monthly data on deaths from all causes in 2021, 2020 and up to 11 years ago for 74 countries and 266 states and provinces were collected through searches on government websites

: the World Mortality Database, the Human Mortality Database and the European Statistical Office.

The data was used in models to calculate excess mortality due to the pandemic, even in those places that do not report weekly or monthly mortality data.

The analysis indicates that global excess deaths due to the pandemic may have amounted to 18.2 million - three times the official figure reported - as of December 31, 2021.

The rate of that excess is estimated at 120 deaths per 100,000 inhabitants worldwide, and it is estimated that 21 countries have rates that exceed 300 deaths per 100,000 inhabitants


The study notes that rates of excess deaths vary dramatically by country and region.

where more and where less

The highest rates per 100,000 population were recorded in

Andean Latin America (512), Eastern Europe (345), Central Europe (316), Southern Sub-Saharan Africa (309) and Central Latin America (274)


Regions and countries such as Lebanon, Armenia, Tunisia, Libya, several regions of Italy and several states in the southern United States would also have registered high rates.

In contrast,

some countries had fewer deaths than expected based on mortality trends from previous years, such as Iceland (48 fewer deaths per 100,000), Australia (38), and Singapore (16).

With 5.3 million excess deaths,

South Asia recorded the highest number of estimated Covid-19 deaths, followed by North Africa and the Middle East (1.7 million) and Eastern Europe (1.4 million). )


By country, the highest number of deaths occurred in India (4.1 million), USA (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 deaths caused by the pandemic over 24 months.

Among these countries, rates of excess deaths were highest in Russia (375 deaths per 100,000 population) and Mexico (325), and were similar in Brazil (187) and the US (179).

Due to its large population, India alone is estimated to account for 22% of all deaths in the world.

In the case of Spain

, and as the study shows in the period analyzed (from January 1, 2020 to December 31, 2021),

the deaths reported by Covid amounted to 98,900, with a rate of 114 per 100,000 inhabitants, while the Estimated excess mortality would be 162,000, reaching a rate of 186 per 100,000 inhabitants.

Taking into account that the latest figure provided by the Ministry of Health on deaths related to the coronavirus amounts to 100,992 deaths, according to the study now published, it could be assumed that this number of deaths in Spain from Covid would be much higher.

Calculating the difference between the estimates of excess deaths and the official reported deaths provides a measure of the underestimation of the true number of deaths caused by the pandemic.

The ratio of excess deaths to those reported is much higher in South Asia (9.5 times higher than reported) and sub-Saharan Africa (14.2 times higher than reported) than in other regions.


The study notes that large differences between excess deaths and official records may be the result of underdiagnosis due to lack of testing and problems with reporting of death data.

According to the authors,

it is crucial to distinguish between deaths caused directly by Covid and those that occurred as an indirect result of the pandemic


Evidence from initial studies suggests that a significant proportion of excess deaths are a direct result of Covid-19.


indirect deaths from causes such as suicide or drug use may also have occurred due to behavioral changes or lack of access to healthcare and other essential services during the pandemic


The impact of these various factors will vary by country and region.

To date,

only 36 countries have published data on causes of death in 2020.

As data from more countries become available, it will be possible to better determine how many deaths were directly due to Covid and how many occurred as an indirect result of COVID-19. infection or responses to it.

Study lead author Haidong Wang, from the US Institute for Health Metrics and Evaluation, said: "

Knowing the true number of deaths from the pandemic is vital for effective public health decision-making

. Countries such as Sweden and the Netherlands suggest that Covid-19 was the direct cause of most of the excess deaths, but we currently do not have enough evidence for most places – further research will help reveal how many were directly caused by the coronavirus and how many occurred as an indirect result of the pandemic.

In any case,

the authors acknowledge a series of limitations in their study


A statistical model was used to predict excess deaths in countries that did not report weekly or monthly data on all-cause deaths, highlighting the need for direct measurements in these locations.

Estimates of excess deaths were calculated only for the entire study period, and not by weeks or months

, due to lags and inconsistencies in reporting Covid deaths that could drastically alter estimates.

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