Undercounting of COVID-19 pandemic deaths by country
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Undercounting of COVID-19 pandemic deaths has been witnessed across the world. Global mortality excess estimates by the World Health Organization are significantly different from official figures, pointing to undercounting– "while 1,813,188 COVID-19 deaths were reported in 2020... WHO estimates suggest an excess mortality of at least 3,000,000." The global average for underreporting COVID-19 deaths in cities is 30%. The aim of arriving at a truer death count is ultimately linked to improving national and international abilities and responses to fighting the virus. Undercounting can cause a number of problems such as delay in vaccines to priority populations.
Lack of resources with regard to testing, differences in how COVID-19 cases and deaths are counted, and other inefficiencies in data collection and updation largely explain this undercounting. In Africa, eight of the 56 sovereign states compulsorily register deaths. In Europe, apart from two countries, all have a universal death registration system. In India 70% of the deaths are registered while medical certificates are given to a minority of these; in 2019 registration of deaths varied significantly from state to state (37% to 100%).
Counting COVID-19 deaths
Counting of COVID-19 deaths is complicated by co-morbidities— classifying whether the person died "of" or "with" the coronavirus. In India in March 2020, the first two coronavirus infected persons to die, officially died due to other illnesses, co-morbidities, and not the virus. In the United Kingdom, following changes in how COVID-19 deaths are counted to only include those within 28 days of a positive test, the number of COVID-19 fatalities diverged from the number of deaths with "COVID-19" listed as a cause of death on death certificates. In April 2020, New York increased its COVID-19 death count to include persons assumed to die from lung diseases but not tested for the virus.
Situation by country
On 17 April 2020, China increased its official figures of deaths from COVID-19 by 50% to correct for undercounting as a result of "undetected deaths at home, late and incomplete reporting". The results of serological survey by the Chinese Center for Disease Control and Prevention released on 28 December 2020 shows that COVID-19 cases in Wuhan may have been may been undercounted to the ratio of 1 to 10.
On average, COVID-19 deaths made up under 10% of the excess deaths between May and August 2020. The estimates of undercounting in Egypt by Institute for Health Metrics and Evaluation (IHME) was in the ratio of 1 to 12. Between the start of the pandemic and May 2021, Egypt registered nearly 200,000 excess deaths, compared ton only 15,000 confirmed COVID deaths, one of the greatest underestimates in the world.
In April and May 2021, a number of India newspapers reported on the discrepancies between the number of cremations at various locations and the official counts for COVID-19 deaths at the same locations, leading to conclusions of undercounting. The Telegraph accessed an order in a rota circulated in a hospital in West Bengal related to COVID-19 deaths which said "In case of Covid positive - No mention of Covid in death certificate." Such cover-ups also contribute to undercounts in the national figures. Not mentioning COVID-19 as the cause of death on the death certificate has caused a number of orphans whose parents died of COVID-19 to become ineligible for orphan specific government schemes.
In April 2020, a Reuters data review found that 2200 people dying in Indonesia of severe COVID-19 symptoms were not part of the government’s tally for deaths due to the virus. In March and April 2020 Jakarta saw excess mortality counts much higher than the number of deaths being attributed to the virus. Around the same time period, the number of burials following COVID-19 precautions were over five times the number of the official government COVID-19 death count. A study that had been conducted between December 2020 and January 2021 had suggested that around 15% of Indonesia's population had already contracted COVID-19, much more than the official percentage of only 0.4% at the time, while a survey conducted in 15–31 March 2021 found that 44.5% of Jakarta's population of 10.6 million people had already contracted COVID-19, compared to the official count of 382,000 (3.6%) at the end of March.
In March 2020, Bergamo had 5,400 deaths as compared to an average of 996 deaths (average taking into past five years). The Wall Street Journal estimated an excess of 352 deaths due to COVID-19 while the confirmed COVID-19 deaths were 201.
In October 2020 Mexico’s National Centre for Preventive Programs and Disease Control came out with a statement that Mexico had undercounted deaths by at least 50,000. However by 29 December 2020 these extra deaths had not been included into the overall death count. On 28 March 2021 Mexico revised its official death toll with an increase of 60%.
Doctors in Pakistan told The Telegraph that in Khyber Pakhtunkhwa stigma was resulting in undercounts. However, an official said that while undercounting was likely, the numbers weren't significant enough relative to the total death count.
On 31 May 2021 Peru revised its official COVID-19 death toll from 69,342 to 180,764. This revision was made following the on-ground situation and reports which were significantly different from official figures. The revision was made by an expert panel formed in April 2021, the panel consisted of health experts from Peru and WHO. Following the revision Prime Minister Bermúdez stated that "we will have more exhaustive figures and figures that will be very useful to monitor the pandemic and take appropriate measures to confront it".
On 28 December 2020 Russia's Federal State Statistics Service released new excess death figures out of which more than 81% were attributed to COVID-19 taking Russia's death toll in 2020 to over 186,000. This was done following reports of undercounting, underreporting, and criticism surrounding Russia's criteria for counting a COVID-19 death. Indicators of death such as ambulance usage and deaths of health workers had also pointed to higher death figures.
As on February 2021, South Africa's excess deaths for the same time period was around three times the official COVID-19 death tally. That is, over 90,000 people died of unknown causes or due to delayed treatment for other health issues.
A study published in Nature Communications estimated that only 1.25% of COVID-19 mortality was reported in Damascus during the first wave, and 12.6% of COVID-19 deaths have been reported in the second wave.
In May 2021, following an analysis by the IHME that the true count of fatalities due to COVID-19 in United States was above 900,000, Anthony Fauci said that "no doubt" there was undercounting of COVID-19 deaths. A study published in The Lancet in September 2020 also pointed to significant undercounting. Undercounting has been reported from Virginia and California. A 2021 scandal involving New York authorities involves undercounting or an alleged cover-up of COVID-19 deaths in nursing homes in 2020.
From June to September 2020, a prospective systematic postmortem surveillance study was conducted in Lusaka to measure the postmortem prevalence of SARS-CoV-2. The study found less than 10% of people who had COVID-19 before death were tested.
Stanford University School of Medicine came out with a study which found that overcounting of COVID-19 hospitalizations in children may be occurring. ThePrint published figures that the Delhi government may have started over-counting; hinting at mortality displacement. Low testing may result in a high death rates, causing overestimates in mortality related modelling.
- "Tracking covid-19 excess deaths across countries". The Economist. 11 May 2021. Retrieved 2021-05-30.
- Wu, Jin; McCann, Allison; Katz, Josh; Peltier, Elian; Singh, Karan Deep (9 February 2021). "The Pandemic's Hidden Toll: Half a Million Deaths". The New York Times. ISSN 0362-4331. Retrieved 2021-05-30.
- "Estimation of total mortality due to COVID-19". Institute for Health Metrics and Evaluation. 2021-04-22. Archived from the original on 21 May 2021. Retrieved 2021-05-28.
- "The true death toll of COVID-19: estimating global excess mortality". www.who.int. World Health Organisation. Archived from the original on 21 May 2021. Retrieved 2021-05-28.
- "COVID-19 death tolls are likely a "significant undercount", WHO says". SWI swissinfo.ch. Reuters. 21 May 2021. Retrieved 2021-05-31.CS1 maint: others (link)
- "Global COVID death toll might be as high as 8m, says WHO". Al Jazeera. 21 May 2021. Retrieved 2021-05-30.
- Cohen, Jon (2021-04-30). "Will India's devastating COVID-19 surge provide data that clear up its death 'paradox'?". Science. doi:10.1126/science.abj2647.
[...] 30% underreporting of COVID-19 deaths in these cities—the worldwide average...
- Guidance for appropriate recording of COVID-19 related deaths in India. National Centre for Disease Informatics and Research, Indian Council of Medical Research. Archived on 10 May 2021 via— archive.org. "Patterns of disease and patterns of death can come from only standardised recording of clinical disease history and cause of death, and therefore epidemiological surveillance of disease and death are important. Robust data is needed from every district and state in India to measure the public health impact of COVID 19 and to plan for timely health interventions and protect communities."
- Banaji, Murad (2021-05-09). "The Importance of Knowing How Many Have Died of COVID-19 in India". The Wire Science. Retrieved 2021-05-27.
Arriving at credible estimates of the epidemic’s true toll could be key to mitigating further disaster.
- Kaneda, Toshiko; Ashford, Lori S. (12 May 2021). "COVID-19 Cases and Deaths in Sub-Saharan Africa Appear Vastly Undercounted". PRB. Retrieved 2021-05-31.
- Rankin, Jennifer; Burgenin, Stephen; Willsher, Kim; Walker, Shaun (2020-04-24). "Is comparing Covid-19 death rates across Europe helpful?". The Guardian. Retrieved 2021-05-30.
- Stancati, Margherita; Sylvers, Eric (2020-04-01). "Italy's Coronavirus Death Toll Is Far Higher Than Reported". Wall Street Journal. ISSN 0099-9660. Retrieved 2021-05-30.
- "Completeness and coverage of death registration data". WHO. Retrieved 2021-05-31.
- "Measuring Africa's Data Gap: The cost of not counting the dead". BBC News. Data journalist: Krystina Shveda. Journalist: Kevyah Cardoso. Senior investigations producer: Louise Adamou. Executive producers: Jacky Martens and Nick Ericsson. Researchers: Maxime Koami Domegni (Senegal) Saikou Jabai Suware (The Gambia), Boubacar Diallo (Guinea), Yasine Mohabeuth (Comoros), Carlos Tobias (Togo), Vincent Niebede (Chad), Alberto Dabo (Guinea-Bissau), Serge Tomondji (Burkina Faso), Crispin Dembasse (Central African Republic), Curtis Slimar (Zambia), Gregory Gondwe (Malawi), Awedni Daweja (Tunisia), Abdelrahman Abutaleb (Egypt). 2021-02-22. Retrieved 2021-05-31.CS1 maint: others (link)
- NB, Devikrishna; Besra, Bishwajeet; Mishra, Nand Lal (6 January 2021). "Birth, death registration improves across states: NFHS-5". Down To Earth. Retrieved 2021-05-28.
- Johari, Aarefa (30 May 2020). "376 burials in 25 days: What explains the surging death rate in Ahmedabad's burial grounds?". Scroll.in. Retrieved 2021-05-28.
- Boyle, Patrick (18 February 2021). "How are COVID-19 deaths counted? It's complicated". AAMC (Association of American Medical Colleges). Retrieved 2021-05-31.
- Pappas, Stephanie (19 May 2020). "How COVID-19 Deaths Are Counted". Scientific American. LiveScience. Retrieved 2021-05-31.
- Pulla, Priyanka (2020-03-17). "The Curious Case of the Deaths That Weren't Due to COVID-19". The Wire Science. Retrieved 2021-05-29.
[...] the first two Indians to succumb to COVID-19 – died not because of the novel coronavirus that is driving a global pandemic but because of the other illnesses they already had.
- "Toll haze in Gujarat: If comorbid, Covid death not counted?". The Times of India. 14 April 2021. Retrieved 2021-05-29.
CM Vijay Rupani had denied reports that the state government was hiding the true count of Covid fatalities. "As per the guidelines of the ICMR, if a comorbid patient dies then a committee of experts decides the primary and secondary causes of death," he said. "If that committee identifies the main cause of death as heart attack, then even if the patient was infected, such a death is not counted as being caused by Covid. The same system is followed across the entire country."
- Biswas, Soutik (2021-05-10). "India's Covid crisis: The newsroom counting the uncounted deaths". BBC News. Retrieved 2021-05-27.
- Reuters Staff (2021-01-15). "Fact check: Changes to the counting of COVID-19 deaths in August reduced England's death toll". Reuters. Retrieved 2021-08-02.
- Syakriah, Ardila (4 May 2020). "An examination of Indonesia's death toll: Could it be higher?". The Jakarta Post. Retrieved 2021-05-31.
- "China, Russia, Brazil and the underreporting of Covid-19 cases". International Observatory of Human Rights. 13 May 2020. Retrieved 2021-05-30.
- "China Boosts Virus Death Tally, Rejects Accusations of Cover Up". Bloomberg. 17 April 2020. Retrieved 2021-06-02.
- "Wuhan's Covid Cases May Have Been 10 Times Higher, Study Shows". Bloomberg. 29 December 2020. Retrieved 2021-06-02.
- "科学认识人群新冠病毒抗体流行率——全国新冠肺炎血清流行病学调查结果问答" [Scientifically understand the prevalence of new coronavirus antibodies in the population. Q&A on the results of the national seroepidemiological survey of new coronary pneumonia.]. www.chinacdc.cn. Chinese Center for Disease Control and Prevention. 28 December 2020. Retrieved 2021-06-02.
- Irfan, Umair (2021-05-07). "How the world missed more than half of all Covid-19 deaths". Vox. Retrieved 2021-05-31.
- Pandey, Kiran (7 May 2021). "COVID-19 may already have killed 650,000 people in India through May 5: Report". Down To Earth. Retrieved 2021-05-31.
- Tracking covid-19 excess deaths across countries
- Langa, Mahesh (2021-04-18). "COVID-19 deaths in Gujarat far exceed government figures". The Hindu. ISSN 0971-751X. Retrieved 2021-05-29.
- "'Burning pyres telling the truth': Dainik Bhaskar says govt data on Covid deaths in Bhopal is a 'lie'". Newslaundry. 16 April 2021. Retrieved 2021-05-29.
- Wallen, Joe; Farmer, Ben; Yusufzai, Ashfaq; Singh, Vivashwan (2020-05-22). "Asia's hidden deaths: coronavirus fatalities are being covered up and undercounted". The Telegraph. ISSN 0307-1235. Retrieved 2021-05-31.
- Sharma, Manoj (2021-06-01). "Children Orphaned by Covid Face New Nightmare in MP, Miss Out on Aid Due to Death Certificates". News18. Retrieved 2021-06-03.
- "Indonesia: More than 2,200 died with coronavirus-like symptoms". Al Jazeera. 28 April 2020. Retrieved 2021-05-31.
- Ghaffarzadegan, Navid; Rahmandad, Hazhir (6 July 2020). "Simulation-based estimation of the early spread of COVID-19 in Iran: actual versus confirmed cases". System Dynamics Review. 36 (1): 101–129. doi:10.1002/sdr.1655. ISSN 1099-1727. PMC 7361282. PMID 32834468.
- Allard, Tom (3 June 2021). "EXCLUSIVE COVID-19 far more widespread in Indonesia than official data show: studies". Reuters. Retrieved 2021-08-09.
- Sood, Amy (14 July 2021). "Almost half of this capital city's population may have contracted Covid-19, survey finds". CNN. Retrieved 2021-08-09.
- Maemura, Akira; Takahashi, Sora (25 May 2020). "Tokyo's excess deaths far higher than COVID-19 count, data shows". Nikkei Asia. Retrieved 2021-05-31.
- Dyer, Owen (2020-10-29). "Covid-19: Mexico acknowledges 50 000 more deaths than official figures show". BMJ. 371: m4182. doi:10.1136/bmj.m4182. ISSN 1756-1833. PMID 33122250.
- Dyer, Owen (2020-12-31). "Covid-19: Russia admits to understating deaths by more than two thirds". BMJ. 371: m4975. doi:10.1136/bmj.m4975. ISSN 1756-1833. PMID 33384283.
- "Covid-19: Mexico revises coronavirus death toll up by 60%". BBC News. 2021-03-28. Retrieved 2021-06-02.
- "Mexico's revised COVID death toll is much higher than before". Al Jazeera. 30 March 2021. Retrieved 2021-06-02.
- Aquino, Marco; Rochabrun, Marcelo (2021-05-31). "Peru revises pandemic death toll, now worst in the world per capita". Reuters. Retrieved 2021-06-02.
- Gaurav, Kunal (2021-06-01). Chaturvedi, Amit (ed.). "Peru revises Covid death toll to almost thrice. 20 countries with most per capita deaths". Hindustan Times. Agency inputs. Retrieved 2021-06-02.
- "Coronavirus digest: Peru more than doubles its COVID-19 death toll". DW. AP, AFP, Reuters. 1 June 2021. Retrieved 2 June 2021.
- "Russia admits COVID toll third-worst in the world; deaths due to virus three times higher than official figure, say officials". Firstpost. Agence France-Presse. 2020-12-29. Retrieved 2021-06-02.CS1 maint: others (link)
- Felter, Claire (10 May 2021). "By How Much Are Countries Underreporting COVID-19 Cases and Deaths?". Council on Foreign Relations. Retrieved 2021-06-02.
- Watson, Oliver J.; Alhaffar, Mervat; Mehchy, Zaki; Whittaker, Charles; Akil, Zack; Brazeau, Nicholas F.; Cuomo-Dannenburg, Gina; Hamlet, Arran; Thompson, Hayley A.; Baguelin, Marc; FitzJohn, Richard G. (2021-04-22). "Leveraging community mortality indicators to infer COVID-19 mortality and transmission dynamics in Damascus, Syria". Nature Communications. 12 (1): 2394. Bibcode:2021NatCo..12.2394W. doi:10.1038/s41467-021-22474-9. hdl:10044/1/86632. ISSN 2041-1723. PMC 8062464. PMID 33888698.
- Haseltine, William A. (4 November 2020). "Lancet Study Suggests U.S. Is Massively Undercounting Covid-19 Cases". Forbes. Retrieved 2021-05-31.
- Anand, Shuchi; Montez-Rath, Maria; Han, Jialin; Bozeman, Julie; Kerschmann, Russell; Beyer, Paul; Parsonnet, Julie; Chertow, Glenn M. (2020-10-24). "Prevalence of SARS-CoV-2 antibodies in a large nationwide sample of patients on dialysis in the USA: a cross-sectional study". The Lancet. 396 (10259): 1335–1344. doi:10.1016/S0140-6736(20)32009-2. ISSN 0140-6736. PMC 7518804. PMID 32987007.
- Coutu, Peter (6 June 2020). "Virginia may be significantly undercounting the coronavirus' real death toll". pilotonline.com. Retrieved 2021-05-31.
- Neilson, Susie; Sumida, Nami (2021-05-29). "How large was the undercount of COVID-19 deaths across California?". San Francisco Chronicle. Retrieved 2021-05-31.
- Valle, Lauren del; Andone, Dakin (29 January 2021). "New York State Department of Health undercounted Covid-19 deaths in nursing homes, attorney general's report says". CNN. Retrieved 2021-05-31.
- "Andrew Cuomo insists New York didn't cover up nursing home Covid-19 deaths". the Guardian. Associated Press. 2021-02-15. Retrieved 2021-08-02.
- Mwananyanda, Lawrence; Gill, Christopher J.; MacLeod, William; Kwenda, Geoffrey; Pieciak, Rachel; Mupila, Zachariah; Lapidot, Rotem; Mupeta, Francis; Forman, Leah; Ziko, Luunga; Etter, Lauren (2021-02-17). "Covid-19 deaths in Africa: prospective systematic postmortem surveillance study". BMJ. 372: n334. doi:10.1136/bmj.n334. ISSN 1756-1833. PMC 7887952. PMID 33597166.
- Rodriguez, Adrianna (19 May 2021). "Hospitals may be overcounting how many kids are admitted for COVID-19 in the US, study finds". USA TODAY. Retrieved 2021-05-31.
- Bedi, Aneesha (2021-05-24). "Delhi govt was first under-counting Covid deaths. Now, it is over-counting". ThePrint. Retrieved 2021-05-28.
- Schwalbe, Nina (4 April 2020). "Why we're overestimating the mortality rate for COVID-19". World Economic Forum. Retrieved 2021-05-31.
- Excess Deaths Associated with COVID-19. National Center for Health Statistics. Centers for Disease Control and Prevention. United States. Accessed on 30 May 2021.
- Classifying and certifying COVID-19 deaths
- International guidelines for certification and classification (coding) of covid-19 as cause of death. World Health Organisation. 16 April 2020. Accessed on 31 May 2021.
- "Guidance for certifying COVID-19 deaths". College of Physicians and Surgeons of British Columbia. BC Vital Statistics Agency and Statistics Canada. March–April 2020. Retrieved 2021-06-03.CS1 maint: others (link)
- "Certifying deaths during COVID-19 outbreak". Medical Defence Union, Ireland. 11 May 2020. Retrieved 2021-06-03.
- Department of Health & Family Welfare, Government of Kerala (2020). Discussion paper COVID 19 Ascertaining cause of deaths: Myths & Facts. Directorate of Health Services, Government of Kerala. Accessed on 3 June 2021.
- Guidance for doctors completing Medical Certificates of Cause of Death in England and Wales (FOR USE DURING THE EMERGENCY PERIOD ONLY) Office for National Statistics, United Kingdom.
- National Vital Statistics System (April 2020). Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID–19). Vital Statistics Reporting Guidance. Report No. 3. National Center for Health Statistics, Centers for Disease Control and Prevention.