The coronavirus has now taken 300,000 lives globally, according to official figures. But depending on the way deaths are counted, the real human cost could be far greater.
The official figures include only those deaths attributed to Covid-19 through testing, but experts are increasingly looking at data comparing this year’s death rates with previous years — regardless of the official cause.
This “excess deaths” metric raises the spectre of a much higher toll, as it includes fatalities indirectly related to the virus — for example, people suffering from other illnesses who could not access treatment because of the strain the pandemic has placed on hospitals.
Throughout the crisis, methods of data compilation have differed widely between nations, making direct comparisons difficult. Experts believe cases of coronavirus are undercoutned by between a factor of five to one of hundred.
In Italy, between February 20 and March 31, 12,428 people were recorded as having died of the coronavirus. But in the same period, authorities noted 25,354 “excess deaths” compared with the average of the five previous years.
For the United States, the difference is even more striking: according to data for March, before the country was hit by the worst of the pandemic, the number of excess deaths reached 6,000 — more than triple the official Covid-19 toll.
Even in Germany, widely considered by experts to have handled the outbreak better than other EU countries, 3,706 deaths more than the average were noted in March, even as the official virus toll was 2,218.
In Guayaquil, Ecuador where the Covid death count is officially 1,200, health officials acknowledge that there have been 9,000 to 10,000 excess deaths since early March.
In France, by contrast, for the period from March 1 to April 27, the COVID-19 toll of 23,291 is very close to the total number — 24,116 — of additional deaths compared with 2019.
Even without a standardised counting method, excess mortality data is the best indicator of how the virus has impacted different countries, said professor Yvonne Doyle, the medical director of Public Health England. “This is a comparable measure internationally. So we would then be able to understand how we have been impacted internationally as well,” she said.
But experts also caution against reading too much into the figures and jumping to conclusions about which countries have dealt with the pandemic best. “These are statistical increases… But we cannot say what these increases are due to,” said Fernando Simon, head of the emergency centre at the Spanish health ministry.
“This excess mortality is due to the crisis as a whole,” agreed Michel Guillot, head of research at France’s Institute of National Demographic Studies (INED). “There may be indirect effects, such as an increase in other causes of death, because we know that people have gone to seek medical help less.”
Italian officials have acknowledged that excess mortality could include coronavirus victims who were not counted as such, and sick people who died as a result of saturated hospital systems.
According to data from 24 European countries compiled by Danish epidemiologists in what is known as the Euromomo project, there was a rise in mortality in March 2020 compared with previous years. “There’s nothing else that could explain the excess of deaths. If it was in January, some of this could have been explained by influenza. And there has been no volcanic eruption or earthquake in Europe,” said Lasse Vestergaard, coordinator of Euromomo. “Those figures are an early picture of the situation.”
The increase in mortality is most pronounced in areas hit hardest by the epidemic, by a factor of two in Paris or the Guayas Province, Ecuador, where Guayaquil is located, while in the Italian region of Bergamo the number of deaths surged by 568 percent on previous years.
The Euromomo data shows that Spain, Italy, France and Britain had significant excess mortality in March and April, but this was absent in countries like Norway and Finland that escaped the worst of the pandemic.
Elsewhere, a lack of transparency in the data makes conclusions even more tentative. Iran, the worst-hit Middle Eastern country, has not published detailed mortality figures since December 2019.
Russia, which has now notched up the world’s largest number of coronavirus cases after the United States, has reported relatively few deaths from the virus, but media reports have been mounting of Covid-19 deaths wrongly ascribed to pneumonia.
There are also doubts about China, where the pandemic began, though officials insist the situation is now under control. In Wuhan, the city that was the origin of the outbreak, unusually large numbers of families were reported to have recovered funeral urns when the lockdown was lifted.