COVID-19 is more severe than you think

Perspectives on pandemic mortality that go beyond the official data

We explore alternative estimates of the cumulative mortality toll of the pandemic and compare based on these estimates how severe COVID-19 has been relative to the leading causes of death before the pandemic. 

Four perspectives

This leads us to four different perspectives on the severity of the mortality impact of the COVID-19 pandemic, which are based on the following data:

  • Reported COVID-19 deaths as per official data sources of country health authorities
  • Lower-bound estimates of all-cause deaths as per the lower bound of the 90% confidence interval (2-sided) of the estimates derived from the excess death model by The Economist
  • Mid-point estimates of all-cause excess deaths as per the same confidence interval. 
  • Upper-bound estimates of all-cause excess deaths as per again the same confidence interval.

These estimates are then compared with the leading causes of death before the pandemic, where we focus on the Top 3 causes of death in 2019 at the level of each country. For a discussion of methods and caveats, check out the earlier companion post

The image gallery above sums up the analysis. As one scrolls through the different concepts, we get a progressively more severe picture of the pandemic.  The overarching result is that the pandemic has been anything but mild in most parts of the world.  Let us now discuss these results.

Discussion by World Bank region

In what follows, we examine the results by World Bank region:

Latin America & Caribbean (LAC) is by far the most severely affected throughout the comparisons. The official death toll already exceeds the #1 cause before the pandemic in most countries. This reflects the severity of the pandemic in this region, but also the practice in several countries to conform the official data to excess death tallies (as in Ecuador and Peru for example).

North America (NAM), which includes Canada and the United States, also portrays a consistent picture across the alternative measurements. There is however a huge difference between Canada and the US, with the former outperforming the latter by a considerable margin. 

Europe and Central Asia (ECA) show different patterns. Parts of Europe turn quite green once we shift from reported COVID-19 deaths to excess deaths (at least of the lower-bound estimates). Most parts of Europe however see progressively worse assessments and the upper-bound excess estimates put pretty much everyone in a more dire position.  Note also that the picture for Central Asia follows that of Eastern Europe.

Sub-Saharan Africa (SSA) is the big puzzle. The reported COVID-19 mortality toll is not comparable to the top-3 leading causes of deaths in the region, except for a few countries in Southern Africa. That picture remains pretty robust once we move to lower-bound estimates for excess deaths (except for Sudan). However, once we get into the mid-points and beyond, the picture becomes much more severe. 

Middle East & North Africa (MNA) show a pattern of turning from sporadically green (including in some large countries in the Middle East such as Saudi Arabia) when it comes to the official statistics on COVID-19 deaths into different shades of red using excess death estimates. 

South Asia (SAR) is turning red very quickly once we transition from reported COVID-19 stats to excess death estimates. India, the largest country in this region, reaches the top causes of death already for the lower-bound of the 90% CI, with the mid-point estimate suggested that the cumulative excess death toll of the pandemic has been more severe than India’s top cause of death in 2019. Not only does South Asia have the highest excess death rate in the world, the high rates translate into large absolute numbers given the huge population in this region. 

East Asia & Pacific (EAP) is homogeneously green when it comes to official mortality stats, but highly diverse when we compare with the various excess death estimates. Southeast Asia follows the typical pattern of becoming progressively red, with Indonesia taking the lead. The rest of this region, however, remains entirely green even under the upper-bound estimates. This includes upper-middle-income China and Malaysia and high-income Australia, Japan, New Zealand and South Korea.

This completes the description. A detailed discussion of the large standard errors and potential for bias in the estimates can be found in the original post

Interactive charts with country details

Below we provide the maps for the different concepts of mortality in interactive format, so country details and calculations can be retrieved (click on the tooltips for details). These maps also include sources and notes.  

Finally, note that non-interactive versions of these maps can be downloaded here:

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