Official covid-19 death tolls still under-count the true number of fatalities
As covid-19 has spread around the world, people have become grimly familiar with the death tolls that their governments publish each day. Unfortunately, these tend to under-count the true number of fatalities that the disease has already caused. In many places, official daily figures exclude anybody who did not die in hospital or who did not test positive. Often the cause of death takes several days to establish and report, which creates a lag in the data. And even the most complete covid-19 records will not count people who were killed by conditions that might normally have been treated, had hospitals not been overwhelmed by a surge of patients needing intensive care.
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A better way to measure the damage caused by such a medical crisis is to look at “excess mortality”: the gap between the total number of people who died from any cause, and the historical average for the same place and time of year. The charts below use data from EuroMOMO, a network of epidemiologists who collect weekly reports on deaths from all causes in 24 European countries, covering 350m people.
Compared to the baseline average of deaths from 2009-19, the flu seasons of 2017, 2018 and 2019 were all unusually lethal. But the covid-19 pandemic, which arrived much later in the year, has already reached a higher peak—and would have been far more damaging without social-distancing measures. EuroMOMO’s figures suggest that there were about 170,000 excess deaths between March 16th and May 17th.
We cannot compare EuroMOMO’s reports directly to official covid-19 tolls, because the organisation does not publish absolute numbers of deaths for each country. Instead, we have gathered data separately from statistical bureaus around the world (see table below). Some Western nations began releasing regular updates in early April, as we first reported at the time. A few—such as Italy and the Netherlands—show an excess of deaths that is far greater than the official covid-19 tally for the same period.
That discrepancy will surely be greater in poorer countries, which have less capacity for testing and treating patients. For example, data about burials in Jakarta, Indonesia’s capital, suggest that the official covid-19 figures in March and April might have captured only 14% of the true toll. As more places start to publish their total mortality figures, The Economist will report and analyse them on this page.
Italy was the first European country to be overrun by the virus. On May 27th its official count of covid-19 deaths was over 33,000. Yet the true toll is much higher. Giorgio Gori, the mayor of Bergamo, a northern town hit especially hard, has said that the daily data are “the tip of the iceberg…too many victims are not included in the reports because they die at home.” The official covid-19 tally, published by the ministry of health, includes only people who tested positive before passing away.
So far, Italy’s national statistical bureau has only published figures of deaths from all causes up until March 31st, covering 6,800 of the country’s 7,900 municipalities. Between February 26th (the week Italy passed 50 official fatalities) and March 31st, the country suffered 12,200 official covid-19 deaths. This figure is 51% as high as the 24,000 excess deaths from all causes registered during the same period.
Spain has experienced a similar outbreak, with its official covid-19 death toll over 27,000 on May 27th, according to data from hospitals. The national epidemiology centre is publishing figures for deaths from all causes. Between March 11th (the week Spain passed 50 official fatalities) and May 19th, the country recorded 27,800 official covid-19 deaths. This figure is 90% as high as the 30,900 excess deaths from all causes registered in the same period.
France’s official covid-19 death toll accelerated rapidly in April, after its central health authority began including people who died in nursing and care homes. By May 27th, almost 40% of the 29,000 recorded national fatalities came from such institutions. Our chart for the whole of France includes these extra numbers. But our charts for individual regions do not, because the care-home data have not yet been broken down geographically.
France’s national statistical bureau has published figures for deaths from all causes. Between March 11th (the week France passed 50 official fatalities) and May 5th, the country recorded 25,500 official covid-19 deaths, including those from care homes. This figure is 95% as high as the 26,700 excess deathsfrom all causes registered in the same period.
Britain’s daily covid-19 toll, which is published by the health ministry and based on submissions from hospitals and care homes, was over 37,000 on May 27th. However, the national statistical bureau has also produced an expanded covid-19 estimate, up until May 15th, after retrospectively analysing the probable causes mentioned on death certificates. These revised numbers are shown in our charts.
Between March 14th (the week Britain passed 50 official fatalities) and May 15th, the country recorded 45,300 official covid-19 deaths, according to the revised estimate. This figure is 77% as high as the 59,100 excess deaths from all causes registered in the same period.
The official covid-19 death toll in the Netherlands stood at 5,900 on May 27th. However, the national institute for public health, which publishes the daily figures, includes only people who have tested positive for the virus (often with a delay).
The Dutch national statistical bureau has published figures for deaths from all causes. Between March 16th (the week the Netherlands passed 50 official fatalities) and May 17th, the country recorded 5,700 official covid-19 deaths. This figure is 60% as high as the 9,400 excess deaths from all causes registered in the same period.
Sweden’s approach to fighting the virus has received much attention, as it is one of the few Western countries that has not enforced a widespread lockdown. On May 27th its official covid-19 death toll was 4,200, counting only people who had tested positive before passing away.
The Swedish national statistical bureau is publishing regular figures for deaths from all causes. Between March 18th (the week Sweden passed 50 official fatalities) and May 12th the country recorded 3,700 official covid-19 deaths. This figure is 92% as high as the 4,000 excess deaths from all causes registered in the same period.
After adjusting for population, Belgium has one of the highest official covid-19 death tolls in the world. On May 27th it stood at 9,400. The country’s health experts have pointed out that this high number includes victims who had coronavirus-like symptoms but did not test positive (many of whom died outside of hospitals). The official covid-19 figures have been retrospectively adjusted to list deaths on the day they happened, rather than the day they were eventually reported.
The Belgian national health institute has also released figures for deaths from all causes, up to April 26th. Between March 23rd (the week Belgium passed 50 official fatalities) and May 10th the country recorded 8,300 official covid-19 deaths. This figure was actually slightly higher than the 7,800 excess deathsfrom all causes registered in the same period
Austria locked down early and has suffered relatively few deaths from the virus. On May 27th its official covid-19 death toll was about 650, counting only people who had tested positive before passing away.
The Austrian national statistical bureau has released figures for deaths from all causes, up to April 5th. Between March 23rd (the week Austria passed 50 official fatalities) and April 5th the country recorded 188 official covid-19 deaths. This figure is 57% as high as the 330 excess deaths from all causes registered in the same period.
After trailing behind the death tolls of many European countries at first, America’s official covid-19 death count rose sharply in April. By May 27th it had passed 100,000 victims, more than any other country. Most American states do not publish recent records of deaths from all causes. But New York City, the worst-affected area, has provided reliable weekly data up to May 9th, as have the states of New Jersey, Illinois, Massachusetts and Michigan.
New York’s health department has adopted a similar approach to Britain’s statisticians, by expanding its definition of covid-19 fatalities and analysing death certificates retrospectively. As of May 27th, it has found an additional 4,800 people who had “probably” died of the virus, along with the 16,600 victims who had tested positive at that point. We have included these revised figures in our chart.
Between March 15th (the week New York passed 50 official fatalities) and May 9th, the city recorded 20,100 official covid-19 deaths, according to the revised estimate. This figure is 86% as high as the 23,500 excess deaths from all causes registered in the same period.
After New York City, the most affected area in the United States has been New Jersey, which has a similar population and suffered 12,300 excess deathsbetween March 15th and May 9th. The state only includes people who tested positive in its official death toll, which was 9,100 in the same period—74% as high as the excess.
Indonesia is one of the first developing countries to have released data about excess mortality—not an official count of deaths from all causes, but instead a tally of burials from Jakarta's department of parks and cemeteries. Typically, the department records about 3,000 burials a month (accounting for roughly three-quarters of all people who die in the city). But during March and April, the department reported 8,800 burials in total, suggesting an excess of at least 2,800 fatalities.
Though Jakarta has been the epicentre of the covid-19 outbreak in Indonesia, at the end of April its official death toll was just 381, barely 14% as high as the excess burials. Even on May 11th, the city’s official tally of dead was still only 450. This suggests that the country is drastically under-counting the severity of the outbreak.
Recep Tayyip Erdogan, Turkey’s president, insists that his government has taken every precaution to fight covid-19, despite not imposing a full lockdown. On May 27th the country’s official death toll stood at 4,400. The last time the government produced a regional breakdown of the figures, on April 1st, Istanbul had roughly 40% of the nation’s deaths and 55% of confirmed cases.
However, data about burials from the city’s government suggest that between March 22nd and May 12th Istanbul suffered at least 3,800 excess deaths. If we assume that the city had roughly half of Turkey’s official toll in that period, that would come to 1,900 official covid-19 deaths, a figure that is 50% as high as the excess.
Sources: ECDC; ISTAT; Ministero della Salute; Instituto de Salud Carlos III; Datadista; INSEE; Santé Publique France; ONS; Centraal Bureau van Statistiek; CDC; New York City Health; Provinsi DKI Jakarta; Statistiska Centralbyran; Epistat; Sciensano; Statistik Austria; Istanbul Metropolitan Municipality. Get the data on GitHub.
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