Why is it hard to count the number of deaths caused by the pandemic?

A new estimate by the World Health Organization suggests that deaths from the pandemic are much higher than official figures – but that is because these figures are unreliable in many places

By Jason Arunn Murugesu

The World Health Organization (WHO) has published a new estimated global death toll from the coronavirus pandemic, saying that there were close to 15 million pandemic-related deaths between 1 January 2020 and 31 December 2021.

This figure is more than double the reported 6.2 million deaths from covid-19, according to data from Johns Hopkins University in Maryland and the WHO’s own figures. Behind this stark difference is the fact that recording deaths of any kind is an inexact science in many parts of the world – something that experts say must be solved.

The WHO’s new estimate is based on the number of fatalities that would have been expected if the pandemic hadn’t occurred. The researchers behind it combined national death data for each country with statistics from scientific studies carried out in the same country. They also used a statistical model to account for deaths that may otherwise have been overlooked.

This method of counting includes deaths directly caused by covid-19, as well as those that were indirectly caused by the pandemic, such as people who died prematurely because healthcare systems were overwhelmed.

The team found that several countries had massively undercounted the number of people who had died in the pandemic. This is particularly apparent in India, which accounts for about half of the extra deaths estimated by the WHO.

By the WHO’s estimates, India has the largest death toll from covid-19 in the world. The team reported that the country experienced 4.7 million excess deaths in this time period, compared with the officially reported covid-19 death toll of 520,000 to date.

But these figures have only made clear what epidemiologists have known for years, says Prabhat Jha at the University of Toronto, Canada: many countries still don’t have effective ways to record their dead. About 60 per cent of deaths aren’t registered, according to the WHO.

“In 2020, India had 10 million deaths and 3 million of those were simply not registered,” says Jha, who was part of a team that conducted a study on covid-19 deaths in India. This difference is largely because half of deaths occur at home and bodies are quickly cremated in order to maintain Hindu and Muslim traditions, he says. “It’s even worse in rural areas, as people, especially women, are less likely to be registered [when they die],” he says.

The WHO’s findings and Jha’s study suggest that previous hope that India would better weather the pandemic due to its young population was flawed. “Now we know we were just looking at the data too early,” he says.

A lack of covid-19 data is also an issue in many African countries, says Jha, masking the continent’s true death toll. Out of 47 countries on the continent, only five of them provided any empirical data to the WHO.

Solving these issues globally is vital, says Ariel Karlinsky, who maintains the World Mortality Dataset, which a lot of the WHO figures are based on. “Knowing the true death toll of the pandemic is the first step to better understanding what happened and to prevent future outbreaks,” he says.

Jha says tackling these problems isn’t impossible. “You have to insist that you can’t dispose of a body without registration – which is what Mumbai [in India] does now,” he says. “They have pretty close to a 100 per cent death registration now and they’ve had that system for years.”

“Rural areas are still a problem,” he says. “I think some innovative thinking is required, such as setting up village registrars in order to have every death recorded.”

“It’s just astonishing in the 21st century that we don’t have a handle on how many covid-19 deaths have occurred,” says Jha.

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