The true death toll of the COVID-19 pandemic may be 3 times higher than official global estimates, new study says

• Around 18.2 million people may have died as a result of the COVID-19 pandemic, a new study says.
• This number shows how many additional people died over indirect medical issues related to COVID-19.

The number of people who died in 2020 and 2021 because of the COVID-19 pandemic may have been three times higher than the official death toll, a new study published in The Lancet has found.

Official estimates say that around 6 million people have died directly because of COVID-19, but a group of 96 contributing researchers now estimate that a total 18.2 million may have passed away worldwide due to the crisis.

The peer-reviewed study assessed mortality reports from 74 countries and 266 provinces or states between January 1, 2020, and December 31, 2021. It used the data to predict the number of excess deaths around the rest of the world.

Excess deaths refer to deaths from all causes during the pandemic, and not just people who died directly because of the coronavirus. This includes deaths from secondary issues that arose in the last two years due to the pandemic, such as the severely sick not being able to access medical care when hospitals are overwhelmed.

As such, excess deaths show how many more people died during the crisis compared to if the pandemic never happened — an indicator of the true collateral damage of COVID-19.

"Understanding the true death toll from the pandemic is vital for effective public health decision-making," said lead author Professor Haidong Wang, from the Institute for Health Metrics and Evaluation in the University of Washington, in a statement.

The US suffered the second-highest number of excess deaths, but the excess mortality rate was highest in Bolivia

The global excess death rate due to COVID-19 was 120.3 deaths per 100,000 people, the researchers said. However, 21 countries had an excess mortality rate of 300 deaths per 100,000 people.

In the US, 1.13 million additional people died because of the coronavirus crisis, the second-highest in the world, the study said, compared to the Centers for Disease Control and Prevention's estimate of 961,000 COVID-19 deaths.

According to the study, India suffered the most excess deaths — a staggering 4.7 million people. The country's official COVID-19 death tally is 515,459, according to the World Health Organization.

Russia, Mexico, Brazil, Indonesia, and Pakistan each saw more than 500,000 excess deaths. Those countries, along with India and the US, accounted for more than half of all global excess deaths due to COVID-19 until 2021, the study said.

But the excess mortality rate was highest in Bolivia, where 734.9 excess deaths occurred out of 100,000 people, the researchers added. In comparison, the US experienced an estimated 179.3 excess deaths per 100,000 people.

"The full impact of the pandemic has been much greater than what is indicated by reported deaths due to COVID-19 alone," the researchers wrote. "Strengthening death registration systems around the world, long understood to be crucial to global public health strategy, is necessary for improved monitoring of this pandemic and future pandemics."

They also highlighted that further research is needed to nail down the exact causes of these excess deaths.

Notably, five locations showed a negative excess death rate, or an indication that fewer deaths occurred in these places during the pandemic compared to prior statistical averages — Iceland, Australia, Singapore, New Zealand, and Taiwan.