What is the real COVID-19 death toll? Are we over-counting deaths?

Data and Metrics

A: Sadly, we are most likely UNDER-COUNTING Covid-19 deaths.

Among the most persistent COVID-19 myths is the idea that COVID-19 deaths are being over-counted, including stories of victims of motorcycle accidents getting tested in the hospital so they can be counted as COVID-19 deaths, or the infamous line that people are dying *with* COVID-19 rather than *of* COVID-19.

While there are almost certainly deaths that have been miscoded and COVID-19 deaths among people who would have died soon anyway, demographers have a way of getting around this messiness in assessing the real death toll of big mortality “shocks” to a population like natural disasters or pandemics.

➡️ We call this “EXCESS MORTALITY.”

As the name suggest, excess mortality tallies the number of deaths ABOVE & BEYOND those that would have been expected based on previous years. The benefit of this measure is that it does not rely on how COVID-19 deaths are coded—it counts deaths from ANY CAUSE- which most developed countries are pretty good at accurately counting (so they don’t have to pay out that social security/pension forever!).

While there are some slightly more complicated ways to do this, in essence “excess mortality” uses the average number of deaths in previous years as the baseline for “expected” deaths. These baseline deaths are the counterfactual—meaning what would deaths in a country have looked like in the last year in a bizarro world *without* COVID-19?

So the question is how many MORE deaths from ALL CAUSES have we seen since the pandemic started compared to the average previous years? In many countries, these excess deaths substantially exceed official numbers of Covid-19 deaths.

➡️ Official death statistics lag by several weeks, but the latest U.S. Centers for Disease Control estimates through Feb 20th estimate *567,098* excess deaths in the U.S since Feb 1, 2020—this is 15% HIGHER than the number of deaths with COVID-19 on the death certificate.

➡️In the UK, excess deaths have surpassed 100,000, almost 20% higher than the average in previous years.

Other extremely hard hit countries include (see attached image from FT):

➡️Mexico: 335K excess deaths, 52% higher than normal
➡️Brazil: 220K excess deaths, 23% higher than normal.
➡️South Africa: 124K excess deaths, 28% higher than normal.

One challenge in using excess mortality is that it captures both “direct” and “indirect” deaths due to the pandemic.

“Direct” deaths are those caused by the virus but that might not have been counted as such, especially early in the pandemic when testing was less frequent.

“Indirect” deaths can occur from other causes when hospitals are overwhelmed and/or patients delay seeking care. Indirect deaths would also include increased deaths due to the social or economic impacts of the pandemic.

❓How do we know how many excess deaths were direct or indirect? It’s difficult to know for sure, but so far excess mortality tracks closely the path of the virus across time and space in most countries. This correspondence of excess mortality with the path of the virus suggests many of the excess deaths are due to the virus itself AND indirect deaths due to overstretched health care capacity.

Since lockdown restrictions and the economic impacts are more widespread across the population, the spatial pattern of excess mortality does not suggest these types of “indirect” deaths were a large contributor to excess deaths, but we will learn more as more detailed cause of death data is released in the coming months. So far there is little evidence that suicide rates have increased, for example. But we should remember that the health and mental health effects of social and economic impacts of the pandemic will also play out over the longer term.


💥Excess deaths account for the fact that some people who died of COVID-19 would have died anyway, and only counts what is above and beyond what is expected.
💥Excess deaths were seen in all countries hard hit by the pandemic, but not in countries that have not (South Korea, Norway, Finland, Australia). In most countries excess deaths have been HIGHER, not LOWER than official COVID-19 deaths.

🙌 Hope is on the horizon! Remember that each COVID death we can prevent now need never happen once that person is vaccinated.

Those Nerdy Girls

Further reading:

Global Excess Mortality Estimates

US and State by State Excess Mortality Tracker

US Mortality Data CDC

Financial Times Excess Mortality Tracker

Our World in Data Excess Mortality Explorer

UK ONS Weekly Mortality Data

Data on Suicides:

Tyler Black on Twitter


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