Global Covid death toll 3 times higher than the usual stats suggest, and much more skewed towards poor countries

May 18, 2021

     By Duncan Green     

Some really important number crunching in The Economist this week. They have built an estimate of the number of ‘excess deaths’ worldwide – that is mortality above the pre-Covid average. This gives you a more accurate picture of how many people have died, because so many Covid deaths are not recorded as pandemic-related (whether because of weak stats systems, or governments keen on covering up the full extent of the death toll).

Where reliable national total death stats exist already, they used those. Elsewhere they had to find proxies, such as regional averages (how they used 121 different variables to do this is explained in more detail by their uber-geek statistician in the video below).

What did they find?

‘Our model suggests that covid-19 has already claimed 7.1m-12.7m lives. Our central estimate is that 10m people have died who would otherwise be living. This tally of “excess deaths” is over three times the official count.’

‘The most important insight from our work is that covid-19 has been harder on the poor than anyone knew. Official figures suggest that the pandemic has struck in waves, and that the United States and Europe have been hit hard. Although South America has been ravaged, the rest of the developing world seemed to get off lightly.

Our modelling tells another story. When you count all the bodies, you see that the pandemic has spread remorselessly from the rich, connected world to poorer, more isolated places. As it has done so, the global daily death rate has climbed steeply.

India, where about 20,000 are dying every day, is not an outlier. Our figures suggest that, in terms of deaths as a share of population, Peru’s pandemic has been 2.5 times worse than India’s. The disease is working its way through Nepal and Pakistan. Infectious variants spread faster and, because of the tyranny of exponential growth, overwhelm health-care systems and fill mortuaries even if the virus is no more lethal.’

‘Most of the deaths caused by covid-19 but not attributed to it are found in low- and middle-income countries. Our figures give a death rate for the mostly rich countries which belong to the OECD of 1.17 times the official number. The estimated death rate for sub-Saharan Africa is 14 times the official number. And the first-and-second-wave structure seen in Europe and the United States is much less visible in the model’s figures for the world as a whole. Overall, the pandemic is increasingly concentrated in developing economies and continuing to grow.’

the pandemic has spread remorselessly from the rich, connected world to poorer, more isolated places.

‘It is worth noting, though, that despite hitting the poorer parts of the world harder than indicated by data on Covid-related deaths, on a per-person basis Covid-19 really has been worse in richer countries. For Asia and Africa, the average estimated deaths per million people are about half those of Europe (including Russia). India is comparable to Britain, at least for now.

This might sound surprising to Europeans, who have been in lockdown for the better part of a year. How did people in these mostly poor countries see less death despite frequently lacking interventions to curb the spread of the virus and having less well-funded health care? It seems likely that much of the answer comes down to age. If two populations have the same level of health care, the one with more elderly people will see more deaths. If demography were the only difference, estimates of the way that the risk of dying from covid-19 infection varies with age suggest the disease would be 13 times more deadly in Japan (median age 48) than Uganda (median age 17). Reliable excess-mortality data tend to come from countries with older, more vulnerable populations.

Low as they are in absolute terms, though, the death rates among poor young populations are much higher than they would be for populations in the rich world with similar age profiles. And for the elderly in poor countries the outlook is clearly grim. South Africa has seen 120,000 excess deaths among those over 60.

The fact that a relative lack of deaths in developing countries seems to be due to age, rather than anything else, has various implications. One is that the virus is spreading easily among younger people—a finding backed by seroprevalence surveys, which find far higher rates of past infection in Afghanistan, India and elsewhere than they do in Europe or America. This suggests lots of non-fatal cases of disease, something which suggests that the problem of “long covid” will be worse in these countries. It also means that the virus is getting plenty of opportunities to mutate.

There is an exception to this story. In some countries in South-East Asia, deaths seem remarkably low, at least so far. This is not an artefact of the model: excess-death data for Malaysia and Thailand have hardly risen at all. It is possible that people there benefit from “cross-immunities”—a level of protection against sars-cov-2 conferred by past infection by other viruses circulating in the region. Unfortunately, though, there are signs that the figures are now mounting.’

It’s hard to overestimate the importance of these findings. Like HIV/AIDS before it, Covid is becoming a disease of poverty, and much faster than we thought.

And here’s the 8 minutes on the methodology and headline findings

May 18, 2021
Duncan Green