According to a study released Wednesday, deaths directly or indirectly attributable to the first wave of Covid-19 infections in 21 affluent nations earlier this year exceeded government counts by 20 percent on average.
Looking at the period from mid-February to May 2020, researchers reported 206,000 more deaths than would have been expected without the pandemic.
But only 167,148 have been officially traced to the coronavirus that has invaded the globe since the beginning of the year, infecting tens of millions.
Many of the approximately 40,000 unaccounted deaths were due to Covid-19 but not listed as such, especially at the start of the pandemic when overwhelmed hospitals in some nations were unable to systematically test patients.
Others could be the result of interruptions in health care, such as failure to treat cancer or lack of access to emergency services following a heart attack or accident.
Excess mortality from all causes over the 15-week period varied markedly among the nations surveyed.
It was the highest in Spain, England and Wales, which recorded 100 “extra” deaths per 100,000 people, about 37% more than would have been expected in the absence of the pandemic.
– Deceptively difficult –
The study found that England and Wales, Spain and Italy accounted for three-quarters of the total number of excess deaths. Belgium and Scotland have also been hit hard.
At the other end of the spectrum, countries that did not show a detectable increase in deaths in the spring included Bulgaria, New Zealand, Slovakia, Australia, the Czech Republic, Hungary, Poland, Norway, Denmark and Finland.
The rest of the countries analyzed – Austria, Switzerland, Portugal, France, the Netherlands and Sweden – fell somewhere in between.
The 206,000 excess deaths were almost equally divided between men and women, a figure in contrast to the death rates reported in hospitals, where a significantly higher percentage of victims were male.
Figuring out exactly how many people died during a pandemic is deceptively difficult, scientists say.
The counts limited to “confirmed cases” will miss many Covid deaths that were misdiagnosed or not tested in the first place.
Methods also vary.
“What counts as death from Covid-19 is defined differently in different countries,” said Kevin McConway, a professor of applied statistics at the British Open University, who was not involved in the study.
– Build a better model –
Such an approach generally compares the number of deaths during a pandemic or other catastrophe with the same period in previous years.
But Ezzati and colleagues went further, building a model “that takes things like seasonality, trend and temperature into account to predict the number that would be expected if there hadn’t been a pandemic,” he explained.
The study showed that countries moving quickly to implement lockdowns would likely see shorter periods of excess death.
There was also a strong statistical link between higher per capita spending on health care and lower rates of excess death during the first wave of infections.
“A strong and equitable health system is the only way to address existing inequalities and make the nation resilient to future pandemics,” Ezzati said.
Meanwhile, a study published Monday in the Journal of the American Medical Association (JAMA), also based on an analysis of death records, found that for every two deaths in the United States directly attributed to Covid-19 from March to July , a third American also died from the pandemic.
All-cause deaths in the United States – normally stable year-on-year – increased by 20 percent over the period reviewed, the study found.
The data also showed that the first states to ease restrictions on public meetings in April and May also saw faster spikes in infections and deaths in the following months.
“The high tally in the sun belt” – including Texas, Arizona and Florida – “shows us the dire consequences of how some states have responded to the pandemic,” said lead author Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University.
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