The true death toll of Covid-19

And why masks still matter

CLINICAL MATTERS

With the All-Souls Day celebration last week, it seems like as good a time as any to examine how many people we have lost during the pandemic. The official global death toll due to Covid-19 stands at about 6.6 million. That is most definitely a gross underestimate. Not everyone who died was tested for one reason or another. Whether it is a lack of tests, a refusal to test, or Covid-19 was not considered as a possible cause of death, there are many uncounted Covid-19 deaths from each country. In addition, indirect deaths in which Covid-19 contributed to the demise are harder to count, not to mention downstream effects on the healthcare system that affected care of people with non- Covid-19 ailments.

The easiest way to estimate the impact of Covid-19 deaths, whether direct or indirect, is to look at excess mortality. This involves examining historical averages of death from the last few years and comparing these with the current year. This data is imperfect since there can be substantial delays in reporting mortalities. Excess deaths will not just capture the untested Covid-19 deaths but will also include excess deaths from other causes, and these may be difficult to distinguish. For instance, the delayed screening and detection of certain cancers brought about by the closure of physician clinics during the early phase of the pandemic will translate to higher rates of cancer mortality later. This also does not consider the effects of long Covid-19 on those with cancer who survive their coronavirus infection.

The most comprehensive study looking at excess deaths was done by the World Health Organization (WHO) last May (https://www.who.int/news/item/05-05-2022-14.9-million-excess-deaths-were-associated-with-the-covid-19-pandemic-in-2020-and-2021). Using multiple data s