Nearly two years into a pandemic that continues to rage, the world has now reported its 5 millionth COVID-19 death, according to a count of global deaths maintained by Johns Hopkins University.

That figure is almost equivalent to the total population of New Zealand.

On average, more than 7,000 people are reported as dying of COVID-19 each day. Since April 2020, the number of daily deaths has dropped below 4,000 fewer than 20 times.

But official figures reported by national governments fail to capture the true toll of the COVID-19 pandemic.

Firstly, for every official COVID death there are many more people who have grieved loved ones, been struck seriously ill themselves, or suffered the effects of long COVID.

And the official death toll itself is likely to be vastly underestimated. 

Professor Alan Lopez, a leading international expert on disease burden and health statistics, believes 5 million is a very inaccurate count of the pandemic's death toll. Professor Lopez says the actual figure is likely to be between 12 and 15 million — or close to half of Australia's total population.

This is because deaths are only included in the tally if COVID-19 is officially determined to have been a factor.

Yet many people have died without ever knowing they have the virus. Others who died from non-COVID causes may not have done so if hospital systems had not been so stretched. Other COVID-19 deaths have occurred outside the health system, and were therefore never counted in the official toll.

"People are saying 5 million, but in reality, it's much more than that," says Professor Ali Mokdad from the United States' Institute for Health Metrics and Evaluation (IHME). 

"There is a huge difference between what is being reported, and what is out there in terms of the true number of deaths."

Another way to measure deaths

The clearer way to understand the death toll of the pandemic is by looking at each nation's "excess deaths". This figure reflects the number of people who have died for any reason since the pandemic began, over and above the average number of people that are expected to die in a typical year.

"Mortality is pretty steady, year after year after year," Professor Lopez says. "If you look over the last three or four years and you average out the mortality of each week … and then you look at what's happened in 2020 and 2021, the excess deaths in the absence of anything else are highly likely to be attributable to the various effects of COVID-19."

And many countries — even with no shortage of vaccines  — are still recording many more deaths than in the pre-pandemic baseline.

The United States is one of those nations. The US is currently recording as many as 20,000 deaths a week over and above historical norms.

Professor Mokdad estimates that only around 50 per cent of COVID-19 cases are being detected in the United States. 

High vaccination rates have helped some countries, which suffered through a dreadful 2020, record relatively few excess deaths in 2021.

That includes Spain, one of the hardest-hit countries in the very early waves of the pandemic.

Australia, with its relatively small case numbers, has not recorded significant excess deaths, although all-cause mortality data for the lockdowns in the second half of 2021 have not yet been released by the ABS.

Analysis by The Economist estimates the true global death toll to be somewhere between double and four times the reported figures. This would put the real death toll anywhere between 10.2 million and 19.2 million.

The publication's model puts the most likely figure at more than 16 million deaths, more than triple the figures being reported by authorities.

But there's a lot of uncertainty around those estimates. Many countries don't report death statistics in a timely manner, or even in some cases at all.

This is a significant flaw with using such estimates to drive policy. As Professor Lopez says: "There's no point, for COVID policy today, talking about COVID deaths six months ago."

The hidden pandemic toll

The country with the highest excess death levels through the pandemic is Peru.

The country's weak health system played a significant role in the catastrophic outcome. Hospitals were overwhelmed, and demand for oxygen far outstripped supply. According to an article published by The BMJ medical journal, Peru has just 1,656 intensive care beds for its 33 million population.

Earlier this year, the country revised its COVID-19 death toll to almost three times its initial estimate, pushing it to the top of the list of countries with the highest death rate per capita.

The revision followed long-running warnings from experts that COVID-19 deaths were being undercounted. As of this week, more than 200,000 people have died of COVID-19 in Peru, according to the Johns Hopkins tally.

Across the world, COVID-19 testing is also inaccessible for many, leading cases and deaths to go undetected.

"The reality is, not every country is able to do testing appropriately — and it's expensive," Professor Mokdad says, adding that this is a particular issue for poorer nations.

This low detection rate, he says, is the key driver for underreporting deaths.

The current situation

Notwithstanding problems with official mortality figures, they do paint a picture of how the deaths have risen and fallen across each continent over time.

As Europe heads into winter, this region is again recording almost one third of the world's officially-reported deaths.

Countries on the continent are battling combinations of low vaccination rates (particularly in eastern Europe) and waning immunity in nations that were among the world's fastest to mass vaccinate (particularly in western Europe).

After a dreadful 2020 and the first half of 2021, South America is now reporting below 15 per cent of the world's weekly deaths.

But as the pandemic landscape shifts along with growing vaccination rates, Professor Lopez believes it's crucial to get the statistics right to allow for planning and response to emerging surges in case numbers. 

"Government policy ought to be informed by timely, reliable information on who's dying of what and how that is changing," he says.

"If we have the COVID numbers wrong we may vastly underestimate the impact of what's undoubtedly a very big pandemic, that has already killed 12 to 15 million people in the last 18 months and may kill that number in the next 18 months unless we are able to control it."

Loading form...