Study: Global COVID-19 Death Toll May Be 3 Times Higher Than Official Records Show


Results of an excess-deaths analysis show that 18.2 million individuals have likely died as a result of the pandemic.

More than 3 times as many individuals may have died worldwide as a result of the pandemic than official COVID-19 death records suggest, according to the results of an analysis published in The Lancet.

Official COVID-19 death toll reports estimate the number of related deaths between January 1, 2020, and December 31, 2021, at 5.9 million, but a new excess-deaths analysis estimates that approximately 18.2 million deaths may have occurred during the period.

Excess death toll is the difference between the number of recorded deaths from all causes and the number expected based on part trends, a key measure of the true death toll of the pandemic. The latest analysis suggests that the impact of the pandemic could be far greater than reported.

Although there have been attempts to estimate excess mortality from COVID-19, most have been limited in geographical scope of available data.

The new study provides the first peer-reviewed estimates of excess death in 191 countries and territories between January 1, 2020, and December 31, 2021. Additionally, the study includes 252 subnational locations, such as provinces and states.

Investigators used weekly or monthly data on deaths from all causes in 2020 and 2021, as well as 11 years prior to the pandemic. They gathered the data from 74 countries and 266 provinces and states through searches of the European Statistical Office, government websites, the Human Mortality Database, and the World Mortality Database.

They used the data as models to estimate excess mortality related to the pandemic, including for locations with no monthly or weekly reporting of death data.

The excess death rate is estimated to be about 120 deaths per 100,000 population globally. Additionally, 21 countries were estimated to have rates of more than 300 excess deaths per 100,000 population.

The rates of excess deaths were estimated to have varied by country and region.

The highest estimated excess death rates were in Andean Latin America, at 512 deaths; followed by Eastern Europe, at 345 deaths; Central Europe, at 316 deaths; southern sub-Saharan Africa, at 309 deaths; and Central Latin America, at 274 deaths, per 100,000, respectively.

Several locations outside these regions had similar rates, including several in Italy and in the Southern United States.

The countries that had estimated fewer deaths than expected included Iceland, at 48 fewer deaths; Australia, at 38 fewer deaths; and Singapore, at 16 fewer deaths, per 100,000, respectively.

By contrast, South Asia had the highest number of estimated excess deaths, at 5.3 million, followed by North Africa and the Middle East. At the country level, India had the highest number of estimated excess deaths, followed by the United States, Russia, Mexico, Brazil, Indonesia, and Pakistan.

Investigators calculated the difference between excess death estimates and official reported deaths to provide a measure of undercounting of the pandemic’s true death tolls.

The ratio of excess deaths to reported deaths is greater in South Asia, about 9.5 times higher than reported deaths, and sub-Saharan Africa, about 14.2 times higher than reported, than in other regions.

The large differences between the 2 death toll metrics may be a result of underdiagnosis related to issues with reporting death data and lack of testing, according to investigators.


The Lancet: Global death toll of COVID-19 pandemic may be more than three times higher than official records, estimates of excess deaths indicate. EurekAlert. News release. March 10, 2022. Accessed March 15, 2022.

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