The problem is that 85 of the 194 countries surveyed by the WHO technical advisory group that produced the new estimates do not have good enough death records to make this a viable approach. Forty-one of those countries are in sub-Saharan Africa.
For these countries, a team led by Jonathan Wakefield, a statistician at the University of Washington in Seattle, used data from countries with complete death records to build another statistical model capable of predicting total COVID deaths in any month from other measures, including temperature, the percentage of COVID tests that came back positive, a rating of the stringency of social distancing and other measures to limit infection, and rates of diabetes and cardiovascular disease, conditions that put people at high risk of dying from COVID.
The Indian Ministry of Health strongly opposed this model in its response to the New York Times article. But the WHO team didn’t actually use it to estimate COVID deaths in India. India falls into a middle group of countries that have reasonably good data on total deaths in some regions, but not in others. So Wakefield’s team used data from 17 Indian states with adequate death records, applied the standard excess deaths approach used for countries with complete death records, and then extrapolated from these states to the entire country.
“We only based the predictions of how many people died in India in those two years on Indian data,” Wakefield told BuzzFeed News.
Importantly, the WHO estimates of COVID deaths in India also align well with other studies, including one published in the journal Science in January by a team led by Prabhat Jha, director of the Center for Global Health Research at the University of Toronto in Canada. Jha’s team estimated COVID deaths from Indian government data and a national survey of 137,000 people, conducted by a polling company that asked people if a family member had died from COVID. “India has pretty high mobile coverage and they were dialing digits randomly,” Jha told BuzzFeed News.
Jha’s team estimated that more than 3.2 million people in India had died from COVID by July 2021, most of them during the devastating COVID surge caused by the Delta variant of the coronavirus between April and June 2021. This came after Prime Minister Narendra Modi’s government relaxed COVID controls following an earlier, less severe wave. “The Indian government declared victory and said, ‘Oh, India has defeated this virus,’ and complacency set in,” Jha said.
This explains the political sensitivity in India when it comes to accepting the results of studies that indicate a death toll much higher than the official count. In response to a question from leaders of the opposition Congress party about Jha’s study in February, the Ministry of Health and Family Welfare described it as “speculative” and stated that it “lacks peer-reviewed scientific data,” even though it was published in one of the world’s leading peer-reviewed scientific journals.
“It’s politics,” Jha said of the Indian government’s rejection of his study.
According to the WHO, Egypt has proportionally the largest undercount of pandemic deaths, with excess mortality that is 11.6 times greater than the number attributed to COVID. India, with excess deaths 9.9 times its official COVID death count, comes in second. Meanwhile, Russia has reported 3.5 times fewer COVID deaths than its excess mortality indicates.
Ariel Karlinsky of the Hebrew University of Jerusalem, another member of the WHO technical advisory group, hopes the agency’s “seal of approval” for excess mortality calculations will encourage nations to come up with more realistic figures. “Putin doesn’t know who I am, but they do know who the WHO is,” he told BuzzFeed News.
But instead of acting to correct their COVID death figures, some governments are now apparently withholding the all-cause mortality data used to calculate excess deaths. Belarus, which appears to be underreporting its COVID deaths by a factor of about 12, has stopped reporting its all-cause mortality data to the UN, Karlinsky said. “The sections on mortality just disappeared.”
Right now, the main concern is China, which is experiencing a significant wave of the Omicron coronavirus variant but is reporting suspiciously few deaths. If the wave now hitting Shanghai and other cities matches the pattern seen in Hong Kong since February, Jha fears that a million Chinese could die.
Some countries have responded to excess mortality studies with greater responsibility and transparency. After previous excess death analyzes suggested that Peru was underestimating its COVID deaths by a factor of 2.7, the South American nation reviewed its medical and death records in detail and revised its May 2021 death toll to a figure that closely matched the excess death analysis. It now reports the highest official per capita COVID death rate of any nation. “Peru did what I would have liked all countries to do,” Karlinsky said.
The new WHO estimates of total excess pandemic deaths will include people who died from other causes because health systems were overwhelmed, as well as people who died from the coronavirus.
Karlinsky, who is an economist, said he began analyzing the excess deaths because he wondered if “the cure was worse than the disease”; In particular, he feared that lockdowns could cause more deaths than the coronavirus, partly through increased suicides. But the data tells a very different story.
In countries like New Zealand, which had strict lockdowns but low COVID levels, there are no signs of excess deaths. There is also no evidence of a global suicide epidemic during the pandemic; In the United States, suicides actually decreased. Only in a few countries like Nicaragua, where people appear to have avoided going to the hospital for fear of becoming infected, are there signs that deaths from other causes, such as heart disease, have increased, according to Karlinsky.
“Excess mortality is approximately equal to COVID mortality,” he added.
