A new analysis from scientists at the University of Washington suggests 6.9 million people worldwide have died from COVID-19, more than double the official death toll.
The study from the Institute for Health Metrics and Evaluation (IHME) estimates the total number of U.S. deaths at more than 905,000 — about 60% higher than the 561,594 deaths currently reported by the U.S. Centers for Disease Control and Prevention.
In India, where the disease has overwhelmed the health care system, the UW group estimates more than 650,000 people have been killed by the virus, nearly three times the official count. In Russia, the true number is likely five times higher than reported.
"This analysis just shows how challenging it has been during the pandemic to accurately track the deaths," IHME Director Dr. Christopher Murray said Thursday in a media briefing. "By focusing on COVID's total death rate, we bring to light just how much greater the impact of COVID has been already and may be in the future."
Experts agree that COVID-19 deaths have been widely underreported, but the UW study is the first to attempt to tease out the true number on a global scale. The researchers drew on their long experience producing the Global Burden of Disease report — the most comprehensive assessment of worldwide deaths and disease — to estimate the expected number of deaths in each country during a typical year and compare it with the actual number during the pandemic.
Many COVID-19 deaths go uncounted because some countries only record fatalities that occur in hospitals or in people with confirmed infections, Murray said. Lack of testing has been a problem in many places and record-keeping suffers when medical facilities are swamped with sick and dying patients.
"Mostly, it's just unintentional missing, when health systems get hard hit," he said.
Even in the U.S., many COVID-19-related nursing home deaths were not recorded as such early in the pandemic, and lack of testing meant many infections went undiagnosed. Local medical authorities also vary in whether they attribute deaths to COVID-19 or other underlying conditions that may have aggravated the disease, Murray added.
The UW findings are similar to previous studies that found much higher numbers of so-called "excess deaths" than confirmed COVID-19 deaths. But scientists disagree on how many of those excess deaths are attributed directly to the virus.
The UW group assumes most of them are, but the evidence doesn't really support that, said Dr. Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University School of Medicine.
"We take the position that we just don't have enough data to answer that question," said Woolf, who was not involved in the UW work but has been regularly tallying excess deaths in the U.S. His most recent update found 23% more people died between March 2020 and January 2021 than in normal times, with about two-thirds of those due to confirmed COVID-19.
Some in the other third undoubtedly died from undiagnosed COVID-19, but Woolf and his colleagues also noted increases in the number of deaths due to heart disease, Alzheimer's and diabetes. While undetected coronavirus infections could have also played a role in many of those patients, it's possible people with chronic conditions got worse during the pandemic because they were reluctant or unable to get regular medical care, Woolf said.
The UW team considered several factors that could be responsible for excess deaths, including increased drug overdoses and suicides, missed immunizations and other deferred health care. But they concluded those factors are offset by reductions in deaths from traffic and other accidents and respiratory viruses like flu.
In fact, Murray said he thinks the UW analysis probably underestimates total COVID-19 deaths, primarily due to the absence of influenza during the pandemic.
Woolf said he's skeptical of the UW group's contention that more than 300,000 COVID-19-related deaths in this country were missed. "The health care system got a handle on that quickly enough that for most of 2020 they were doing a good job of laboratory confirmation of COVID-19," he said.
But at least one other preliminary study, from researchers at the Boston University School of Public Health, concluded COVID-19 deaths in the U.S. were 44% higher than reported through October 2020.
Murray and his colleagues estimate the global COVID-19 death toll will reach 9.4 million by September, with nearly 950,000 deaths in the U.S. — which currently leads the world. But by September, India is expected to take over the top spot with 1.4 million deaths.
The study also includes state-by-state death tolls, with the largest gap between reported and actual deaths in Kentucky and the smallest in Massachusetts. For Washington, the study estimates 8,840 people have died from COVID-19, compared with the official number of 5,553.
A spokesperson for the Washington State Department of Health said she couldn't address the specifics of the UW study, but that officials have "always assumed there are uncounted COVID-19 deaths," due to limited testing early on. The state does not count people whose death certificates cite COVID-19 if infection is not confirmed via a positive test.
The UW analysis will be published as part of the next Global Burden of Disease report but has not yet been peer-reviewed. If it's correct, the COVID-19 death toll in the U.S. now exceeds the 675,000 people estimated to have died from the Spanish flu between 1918 and 1920.
