tmtplay net

May 2022

Global excess deaths associated with COVID-19, January 2020 - December 2021

A comprehensive view of global deaths directly and indirectly associated with the COVID-19 pandemic.

 
Line and bar charts of estimated global excess mortality deaths (14.91 million) and reported COVID-19 deaths (5.42 million) between January 2020 and December 2021. Excess deaths increase over 2020 with a dip in February 2021 followed by a May 2021 spike.

The monitoring of excess mortality provides us with a more comprehensive understanding of the impact of COVID-19 beyond the number of COVID-19 deaths reported by countries. The World Health Organization (WHO) is tracking global excess mortality as the pandemic evolves over time to reveal a picture of its full impact and burden on countries, health systems and individuals.

Excess mortality associated with COVID-19 is used to quantify the direct and indirect impacts of the pandemic. 'Excess mortality' is defined as the difference between the total number of deaths that have occurred and the number of deaths that would have been expected in the absence of the pandemic i.e. a no-COVID-19 scenario.

Understanding the excess mortality:

  • Excess mortality includes deaths attributable directly to COVID-19 that were counted and reported to WHO by countries.
  • It also includes deaths attributable directly to COVID-19 that were not counted or reported by countries.
  • It also includes deaths indirectly associated with COVID-19, due to other causes and diseases, resulting from the wider impact of the pandemic on health systems and society.
  • It is minus any deaths that would have occurred under normal circumstances but were averted due to pandemic-related changes in social conditions and personal behaviors e.g. less traffic deaths or influenza deaths due to local lockdowns and less travel.


How to read excess mortality charts

Baseline

The chart has a baseline of zero, representing the number of deaths that should be expected based on existing average mortality data from 2015 to 2019.

Reported COVID-19 deaths

The chart presents a shaded area that depicts the number of COVID-19 deaths that have been reported to WHO by countries.

Estimated excess mortality

The chart lines depict the estimated excess mortality. i.e. the additional people who have died more than the expected number of deaths.

Negative values

The excess mortality line can go below zero. This occurs when less people than expected died due to pandemic related changes in society and behavior.

Observing trends in regions and income groups

The global excess mortality associated with COVID-19 was 14.91 million in the 24 months between 1 January 2020 and 31 December 2021, representing 9.49 million more deaths than those globally reported as directly attributable to COVID-19. The impact of the pandemic has been over several waves with each characterized by unique regional distributions, mortality levels and drivers. Twenty countries, representing approximately 50% of the global population, account for over 80% of the estimated global excess mortality for the January 2020 to December 2021 period. These countries are Brazil, Colombia, Egypt, Germany, India, Indonesia, the Islamic Republic of Iran, Italy, Mexico, Nigeria, Pakistan, Peru, the Philippines, Poland, the Russian Federation, South Africa, the United Kingdom of Great Britain and Northern Ireland, Turkey, Ukraine, and the United States of America (USA). We are able to observe the evolution of the pandemic over these 24 months as different regions and countries were impacted by and responded to the threat of COVID-19.

The difference between reported deaths and excess mortality in WHO Regions

When we chart reported COVID-19 deaths and estimated excess mortality by WHO region, we're able to observe additional trends that help us to understand the impact of COVID-19 upon each region of the world.The following charts intentionally use different scales for each Region. While this does not allow for direct comparison of the charts between regions, the difference between estimated excess mortality in regions requires different scales to allow us to perceive the difference between reported deaths and excess mortality within each region independently.Numbers in red indicate the total excess mortality from 1 January 2020 to 31 December 2021 for each region.

 

The difference between reported deaths and excess mortality in World Bank income groups

When we chart reported COVID-19 deaths and estimated excess mortality by World Bank income group, we're able to observe trends that help us understand how the income level of countries may have affected COVID-19 impact and response.The following charts intentionally use different scales for each group. While this does not allow for direct comparison of these charts between income groups, the difference between estimated excess mortality in income groupings requires separate scales to allow us to perceive the difference between reported deaths and excess mortality within each group independently. The excess deaths are close to reported COVID-19 deaths in high-income countries but much higher in the other country groups.Numbers in red indicate the total excess mortality from 1 January 2020 to 31 December 2021 for each income group.

Understanding uncertainty and estimate ranges

Excess mortality cannot be derived for all countries when using standard methods because of gaps in the underlying data. Therefore, statistical methods are required to derive the expected and total deaths based on the levels of data available for countries; this is why these figures are called 'estimates'.

The methodology for generating the estimates adopts a statistical method called a Poisson regression model and has been developed in collaboration with the (UN DESA) and an appointed Technical Advisory Group for COVID-19 Mortality Assessment.

Our estimates have a range of uncertainty per country and that level of uncertainty is directly related to a country's reporting capacity and variable data quality. As we chart the range between the upper and lower bounds of uncertainty for WHO regions, we are able to observe the relative availability of data for each region and how data gaps disproportionately impact some parts of the world more than others. If the uncertainty bounds are larger, this indicates that there is less available data and therefore, a corresponding greater degree of uncertainty. These ranges in uncertainty serve to highlight the ongoing need and work of WHO, as we partner with countries to strengthen national Health Information Systems, Civil Registration and Vital Statistics Systems and reporting of causes of death, and integrated surveillance systems to help improve data availability and close 'data gaps'.

Excess mortality estimates and model uncertainty by WHO Region

 
More about the COVID-19 excess mortality estimates

Excess mortality estimates, published May 2022, for global, regional and national levels can be downloaded from the tmtplay net:data set page, including age and sex dimensions for the years 2020 and 2021.

In the following months, WHO will continue the official country consultation process with Member States, compiling further data sources and working with UN DESA and the WHO-UN DESA Technical Advisory Group.  
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