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. 2021 Feb 15;7(1):00766-2020.
doi: 10.1183/23120541.00766-2020. eCollection 2021 Jan.

Underestimation of COVID-19 mortality during the pandemic

Stacey Kung  1 , Marjan Doppen  1 , Melissa Black  1 , Irene Braithwaite  1 , Ciléin Kearns  1 , Mark Weatherall  2 , Richard Beasley  1   3 , Nethmi Kearns  1   3
Affiliations

Underestimation of COVID-19 mortality during the pandemic

Stacey Kung et al. ERJ Open Res. .

Abstract

Background: There has been considerable international variation in mortality during the COVID-19 pandemic. The objective of this study was to investigate the differences between mortality registered as due to COVID-19 and the excess all-cause mortality reported in countries worldwide during the COVID-19 pandemic.

Methods: Ecological analysis of 22 countries compared 5-year historical all-cause mortality, reported all-cause mortality and expected all-cause mortality (calculated as historical mortality plus the reported deaths attributed to COVID-19). Data available from the first week of January 2020 to that most recently available were analysed.

Results: Compared to the preceding 5 years, there was an excess of 716 616 deaths, of which 64.3% were attributed to COVID-19. The proportion of deaths registered as COVID-19-related/excess deaths varied markedly between countries, ranging between 30% and 197% in those countries that had an excess of deaths during the period of observation. In most countries where a definite peak in COVID-19-related deaths occurred, the increase in reported all-cause mortality preceded the increase in COVID-19 reported mortality. During the latter period of observation, a few countries reported fewer all-cause deaths than the historical figures.

Conclusion: The increases in all-cause mortality preceded the increase in COVID-19 mortality in most countries that had definite spikes in COVID-19 mortality. The number of deaths attributed to COVID-19 was underestimated by at least 35%. Together these findings suggest that calculation of excess all-cause mortality is a better predictor of COVID-19 mortality than the reported rates, in those countries experiencing definite increases in mortality.

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Conflict of interest statement

Conflict of interest: S. Kung has nothing to disclose. Conflict of interest: M. Doppen has nothing to disclose. Conflict of interest: M. Black has nothing to disclose. Conflict of interest: I. Braithwaite has nothing to disclose. Conflict of interest: C. Kearns has nothing to disclose. Conflict of interest: M. Weatherall has nothing to disclose. Conflict of interest: R. Beasley has nothing to disclose. Conflict of interest: N. Kearns has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
The weekly reported all-cause mortality in 2020, historical all-cause mortality based on previous 5-year mortality data and expected all-cause mortality calculated from historical all-cause mortality plus COVID-19 mortality data in a) 14 European countries (the Financial Times had 1 week of data missing in April for Portugal) and b) eight non-European countries.
FIGURE 1
FIGURE 1
The weekly reported all-cause mortality in 2020, historical all-cause mortality based on previous 5-year mortality data and expected all-cause mortality calculated from historical all-cause mortality plus COVID-19 mortality data in a) 14 European countries (the Financial Times had 1 week of data missing in April for Portugal) and b) eight non-European countries.
See this image and copyright information in PMC

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