“These sobering data not only point to the impact of the pandemic but also to the need for all countries to invest in more resilient health systems that can sustain essential health services during crises, including stronger health information systems,” Tedros Adhanom Ghebreyesus, the WHO’s director general, said in a statement.
Most of the excess deaths during the first two years of the pandemic were concentrated in Southeast Asia, Europe and the Americas, the WHO said. More than two-thirds occurred in just 10 countries, including the United States.
The United States is nearing 1 million deaths caused directly by the coronavirus, a count that does not include those who may have died because they did not get treatment when health systems were overburdened during pandemic surges.
“Among high-income countries, the United States did the worst in terms of excess death rate,” said Steven H. Woolf, director emeritus and senior adviser to the Center on Society and Health at Virginia Commonwealth University School of Medicine, who did not participate in the WHO report. “We have experienced disproportionately high excess death rates because of the way we handled the pandemic.”
Looking at excess deaths allows public health experts and political leaders to gain a better understanding of the true toll of the pandemic. It counts people who died because they did not get treatment for acute emergencies, chronic illnesses and behavioral health conditions such as depression, anxiety or addiction that were exacerbated by the stresses of the pandemic.
“The obvious takeaway is there was a massive loss of life because of the pandemic,” Woolf added.
Middle-income countries experienced 81 percent of the excess deaths, with 53 percent occurring in lower-middle-income nations, according to the WHO analysis. High-income countries reported 15 percent and low-income countries reported 4 percent of the excess deaths.
“The fact that the excess is 2.75 times the reported covid deaths — that’s a startling number,” said Jon Wakefield, a professor of statistics at the University of Washington who was part of the technical advisory group that led the WHO’s modeling efforts.
Several factors contributed to the gulf between the officially reported covid deaths and the WHO’s estimate of excess deaths, Wakefield said. In places where coronavirus testing was not widely available, people may have died from the virus without knowing they had contracted it, he said. And some countries do not closely track deaths: Eight-five countries did not provide any data on covid deaths to the WHO.
“So many deaths go unrecorded in the world,” Wakefield added. “It’s very upsetting in this day and age.”
India, one of the countries hardest hit by the pandemic, rejected the WHO estimate that the crisis had caused nearly 4.7 million excess deaths, making its toll the highest in the world and nearly 10 times the number reported by the government. In a statement, the Health Ministry said that the system of data collection used by the WHO was “statistically unsound and scientifically questionable.”
The WHO estimate confirms what experts have long argued — that the Indian government has understated the pandemic’s toll. The WHO report was delayed due to India’s objection, the New York Times reported in April.
A devastating wave of the coronavirus’s delta variant last year overwhelmed India’s patchy health infrastructure, as hospitals ran out of beds, and oxygen shortages killed patients in the national capital. Cremations were held in parking lots, and dead bodies were found floating in the Ganges River.
This week, the government released data from 2020 that shows an 11 percent increase in deaths that year compared with the two previous years.
“Instead of undermining the WHO numbers, they’ve corroborated the findings,” said Prabhat Jha, an epidemiologist at the University of Toronto. While other countries have accepted there will be some difference between recorded and excess deaths, the pushback from India has been exceptional, he added.
Ariel Karlinsky, an Israeli economist and member of the WHO advisory group that estimated excess deaths, said the organization had asked India to share its data throughout the process. “They have not,” he said.