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Nearly 15 million people died as a result of Covid-19 in the first two years of the pandemic, the World Health Organization estimated in a report released Thursday. That figure is 2.7 times higher than the 5.4 million deaths that governments around the world reported to the global health agency for that period.

The WHO analysis used mathematical modeling to calculate “excess mortality” for 2020 and 2021 — ascribing to the pandemic deaths that were over and above what had been seen in the years leading up to the emergence of the SARS-CoV-2 virus. That means the estimate, 14.9 million, includes both deaths caused by Covid and those that resulted from the fact that the tsunami of Covid cases at times rendered health systems incapable of meeting other needs.

The global health agency’s analysis suggested that the United States ended the second year of the pandemic with close to 1 million Covid-related deaths — a threshold the country is only now approaching based on domestic reports of Covid deaths. The WHO estimates suggested that 932,458 people had died by the end of December 2021, a figure that is 13% higher than the 818,706 deaths the country reported at that time.

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“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,” Director-General Tedros Adhanom Ghebreyesus said in a statement.

The analysis has already been a source of controversy, with the Indian government reportedly having delayed its release.

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The WHO analysis suggests 4.74 million people in India died in the first two years of the pandemic. India itself reported only 481,000 deaths for that entire period, though on Tuesday it acknowledged there were 475,000 extra deaths in 2020 alone. India was hit with a devastating second wave of infections in the spring of 2021, becoming the first country to report more than 400,000 new infections a day. Its official death toll has long been questioned.

Samira Asma, the WHO’s assistant director-general for data, analytics, and delivery for impact, said the agency did not receive the new data from India in time to run it through the model developed for the report.

Using excess mortality to try to estimate the toll of a disease is a well-established methodology. In many countries, including the United States, adult influenza deaths aren’t counted, they are estimated, using formulas that calculate the number of deaths in flu season that are over and above what would be seen at other points in the year.

With the Covid pandemic, excess mortality calculations have to take into consideration deaths that are indirectly linked to Covid — for instance, people with urgent health issues who didn’t go to emergency rooms for fear of becoming infected — and deaths that did not occur because of the pandemic. A number of jurisdictions reported fewer deaths due to car crashes, for instance, especially in the early part of the pandemic. New Zealand, which succeeded in keeping out Covid for months, had negative excess mortality — recording fewer deaths than usual during a global health crisis.

William Msemburi, a technical officer in the department of data, analytics, and delivery, said that 68% of the excess deaths captured by the WHO analysis occurred in just 10 countries, the United States being one of them.

Asma said having a fuller picture of the impact of the pandemic provides countries with information they can use to guide future health policy. “When we underestimate, we under-invest. And when we under count, we may miss targeting the interventions where they’re needed most,” she said.

Correction: An earlier version of this story cited an incorrect figure for the number of Covid deaths reported by the U.S. for 2020 and 2021.

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