The Pandemic’s Hidden Toll: Half a Million Deaths

At least 496,000 more people died last year during the coronavirus pandemic than the official Covid-19 death counts report, a review of mortality data last year in 35 countries shows — providing a clearer, if still incomplete, picture of the toll of the crisis.

Far more people died in most of these countries than in previous years, The New York Times found. The totals include deaths from Covid-19 as well as those from other causes, likely including people who could not be treated as hospitals became overwhelmed. These numbers undermine the notion that many people who have died from the virus may soon have died anyway.

Mortality data in the middle of a pandemic is not perfect. In most places, the disparities between the official death counts and the total rise in deaths reflect limited testing for the virus rather than intentional undercounting. Officially, nearly 2 million people have died of the coronavirus worldwide as of Jan. 12.

But the total death numbers offer a more complete portrait of the pandemic, researchers say, especially because many countries report only those Covid-19 deaths that occur in hospitals.

“Whatever number is reported on a given day is going to be a gross underestimate,” said Tim Riffe, a demographer at the Max Planck Institute for Demographic Research in Germany.

Excess deaths spiked across Europe

After large surges in excess mortality in the spring, most countries across Europe returned to normal levels in the summer. But a second wave of serious illness returned in the fall and continued through the winter, leading to an uptick in mortality once again.

In Belgium and Switzerland, the peaks in mortality in the second half of the year were even greater than in the spring.

These estimates were made for each country by comparing the total number of people who died this year to the number of deaths that would be expected given local mortality trends, adjusted to account for changes over time. The Economist is also tracking these deaths, known as excess deaths, in a similar way.

It is unusual for mortality data to be released so quickly, demographers say, but many countries are working to provide more comprehensive and timely information because of the urgency of the coronavirus outbreak. The data is limited and, if anything, excess deaths are underestimated because not all deaths have been reported.

“At this stage, it’s a partial snapshot,” said Patrick Gerland, a demographer at the United Nations. “It’s one view of the problem that reflects that most acute side of the situation, primarily through the hospital-based system.”

Where excess deaths never returned to normal

The virus was last to hit Latin America, and excess deaths still had not returned to normal levels by the end of the year. Mexico recorded at least 230,800 more deaths than usual compared to the same period in previous years — about two times higher than the reported number of Covid-19 deaths during that time.

Not all countries saw excess deaths

In a handful of countries, however, there was no clear sign of increased mortality in 2020. The reasons for this are varied and will become clearer in the months ahead as countries process and certify deaths.

In Norway, Denmark and Finland, demographers say the low mortality is due in part to a less severe flu season last winter — but also because these countries were quick to implement severe restrictions to slow the spread of the virus when their outbreaks were smaller and easier to contain.

Age breakdowns in mortality data will also provide a clearer picture of the role of Covid-19 in excess deaths. Using relative age-standardized mortality rates, Britain’s Office for National Statistics found that Spain had the highest rate of all European countries during the peak of the pandemic.

Even taking into account differences in mortality by age, experts say the death toll to date could have been much worse.

“Today’s rise in all-cause mortality takes place under conditions of extraordinary measures, such as social distancing, lockdowns, closed borders and increased medical care, at least some which have positive impacts,” said Vladimir Shkolnikov, a demographer at the Max Planck Institute for Demographic Research. “It is likely that without these measures, the current death toll would be even higher.”

Read more about the methodology and download data for excess mortality from The New York Times on GitHub.

To estimate expected deaths, we fit a linear model to reported deaths in each country from 2015 to January 2020. The model has two components — a linear time trend to account for demographic changes and a smoothing spline to account for seasonal variation. For countries limited to monthly data, the model includes month as a fixed effect rather than using a smoothing spline.

Some countries have less historical data available. For countries with three or fewer years of data, the model uses a simple average of deaths in the observed years. For the United Kingdom, the model accounts for the number of bank holidays in a given week, since deaths are not registered during bank holidays.

Tracking the Coronavirus