Conflicting COVID-19 excess mortality estimates

Abstract

The COVID-19 Excess Mortality Collaborators concluded that “The full impact of the pandemic has been much greater than what is indicated by reported deaths due to COVID-19 alone”. They estimate that 18·2 million (95% CI 17·1–19·6) people died worldwide because of the pandemic (as measured by excess mortality) in 2020–21, instead of the reported COVID-19 deaths of 5·94 million worldwide during that period, as WHO claims. I agree with the principle of estimating excess mortality due to the pandemic, not only the reported COVID-19 deaths, but the results of the authors’ recalculation of deaths raise many perplexities.1COVID-19 Excess Mortality CollaboratorsEstimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21.Lancet. 2022; 399: 1513-1536Summary Full Text Full Text PDF PubMed Scopus (222) Google Scholar They found that the gap between estimated excess mortality and reported COVID-19 deaths was much larger in south Asia and sub-Saharan Africa than in other regions. Therefore, the estimated excess deaths for a European country, such as Italy, should be closer to official statistical data. However, in the example of Italy, this is not the case. In Italy, the reported COVID-19 deaths are 137 000 in 2020–21, whereas the authors’ estimated excess deaths are 259 000 (242 000–276 000).1COVID-19 Excess Mortality CollaboratorsEstimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21.Lancet. 2022; 399: 1513-1536Summary Full Text Full Text PDF PubMed Scopus (222) Google Scholar The data published by the Italian National Institute of Statistics2Istituto Nazionale di StatisticaIstituto Superiore di SanitàImpatto dell’epidemia COVID-19 sulla mortalità totale della popolazione residente. Anno 2020 e gennaio-aprile 2021. Sixth report.https://www.iss.it/documents/20126/0/Report_ISS_Istat_2021_10_giugno+%281%29.pdf/3df35cd3-edd5-56e1-5867-d274f5032fb5?t=1623336923282Date accessed: April 20, 2022Google Scholar, 3Istituto Nazionale di StatisticaIstituto Superiore di SanitàImpatto dell’epidemia COVID-19 sulla mortalità totale della popolazione residente. Anni 2020–2021 e gennaio 2022. Seventh report.https://www.istat.it/it/files//2022/03/Report_ISS_ISTAT_2022_tab3.pdfDate accessed: April 20, 2022Google Scholar show an all-cause mortality excess of 100 526 more deaths in 2020 and 63 415 in 2021, compared with the average number of deaths in the 5-year period from 2015 to 2019. This totals to 163 941 more deaths in the 2-year period from 2020 to 2021. These deaths are 95 059 fewer than those calculated by the COVID-19 Excess Mortality Collaborators.1COVID-19 Excess Mortality CollaboratorsEstimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21.Lancet. 2022; 399: 1513-1536Summary Full Text Full Text PDF PubMed Scopus (222) Google Scholar Their numbers are implausible, implying that, without the pandemic, the average mortality in Italy from 2015 to 2019 would be reduced by 7·36% in 2020–21. I declare no competing interests. Conflicting COVID-19 excess mortality estimatesA study1 by the COVID-19 Excess Mortality Collaborators estimates more than 18 million COVID-19 deaths globally by the end of 2021—three times those reported. The COVID-19 Excess Mortality Collaborators claim that under-ascertainment is especially severe in sub-Saharan Africa, with actual deaths 14 times higher than the 150 000 reported—more than 2 million excess deaths across the region in 2020–21. Full-Text PDF Conflicting COVID-19 excess mortality estimates – Authors' replyThe COVID-19 pandemic has caused almost 8 million reported deaths worldwide since late 2019.1 Although this is a staggering loss of human lives, 8 million is a vast under-estimation of the true toll of the pandemic. In addition to under-reporting and misclassification of COVID-19 deaths, the pandemic has also resulted in loss of lives due to stressed health-care systems. Excess mortality due to the COVID-19 pandemic, a measurement of net changes in all-cause mortality during the pandemic compared with levels before the pandemic, is widely considered the best measurement of the overall effect of the pandemic and is increasingly a metric used to compare country performance with expectations. Full-Text PDF Conflicting COVID-19 excess mortality estimatesExcess mortality is an important metric summarising COVID-19 disease burden, informing public health policy and future preparedness needs.1 However, separating the deaths that occurred from COVID-19 versus those from all other causes is challenging. Essentially, the unknowns are the counterfactual, should an infection wave not have happened. A solution to this challenge is to estimate expected number of individuals who would have died and compare this with the observed number of deaths. The estimation of expected number of deaths must consider changes in population and seasonal dynamics and be based on an appropriate reference period. Full-Text PDF Conflicting COVID-19 excess mortality estimatesAlthough the global review of excess deaths from the COVID-19 pandemic might seem to give authorities in some countries encouragement for their policies,1 it seems unfortunate that a key vulnerable group was missing from discussion in the paper. Full-Text PDF Conflicting COVID-19 excess mortality estimatesTo estimate the COVID-19 death toll, the COVID-19 Excess Mortality Collaborators1 have presented excess mortality estimates for 2020–21 for all countries in the world. We argue that for many countries, these estimates are implausible because they imply an unrealistic number of expected deaths, inconsistent with trends before the pandemic. A case in point is Japan, where the authors estimated 111 000 (95% CI 103 000–116 000) excess deaths from Jan 1, 2020, to Dec 31, 2021—an order of magnitude higher than the estimate by The Economist2 (12 000) and qualitatively different from the World Mortality Dataset's3 negative estimate (–13 100). Full-Text PDF Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21The full impact of the pandemic has been much greater than what is indicated by reported deaths due to COVID-19 alone. Strengthening death registration systems around the world, long understood to be crucial to global public health strategy, is necessary for improved monitoring of this pandemic and future pandemics. In addition, further research is warranted to help distinguish the proportion of excess mortality that was directly caused by SARS-CoV-2 infection and the changes in causes of death as an indirect consequence of the pandemic. Full-Text PDF Open Access