Do all countries tell the truth when issuing statistics about deaths to their citizens resulting from the COVID-19 pandemic? One suspects that they don’t, as large numbers of victims scare away tourists and business deals. 

For the past year and a half, many of our decisions regarding whether it is safe to fly to a certain country for business or pleasure have been based a given country’s reported coronavirus deaths.  These statistics give the public a sense of how successful – or unsuccessful – that country has been at containing the spread of the coronavirus and its variant offspring.  

However, not all countries have been playing fair; several have underreported their numbers, either deliberately or due to faulty testing capacities. Comparing the impact of the COVID-19 pandemic between countries or across time is difficult because the reported numbers of cases and deaths can be strongly affected by testing capacity and reporting policy.

Now, two young researchers – one from Israel and one from Germany – have teamed up to set the record straight.  Instead of relying on the countries’ published COVID-19 death rates, they created the World Mortality Dataset, the largest existing collection of overall mortality data, to uncover the true rate of COVID-19 deaths in more than 100 countries.  They published their findings in eLife journal under the title “Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset.” 

In any given period of time, a certain number of people die due to a variety of reasons: old age, illness, violence, traffic accidents and other causes. These deaths are commonly known as “expected deaths,” and researchers use this data to predict the number of expected deaths in the coming months and years. But pandemics, wars, natural and manmade disasters cause additional mortality above and beyond the expected. These are known as “excess deaths.”

“Excess mortality … has long been used to estimate the death toll of pandemics and other extreme events — from the Great Plague of London in 1665, to the influenza epidemic in London in 1875, the XX–XXI century influenza pandemics of 1918, 1957, 1968, 2009  as well as seasonal influenza epidemics and more recently for Hurricane Maria in Puerto Rico in 2016 . Even though the excess mortality does not exactly equal the mortality from COVID-19 infections, the consensus is that for many countries it is the most objective possible indicator of the COVID-19 death toll,” the two researchers wrote. 

To calculate a given country’s true COVID-19 death toll, Ariel Karlinsky, a graduate student at Hebrew University of Jerusalem (HUJI)’s economics department, and Dmitry Kobak from Germany’s Tübingen University collected mortality data from 103 countries.  “We gathered mortality data to answer a number of questions,” Karlinsky explained. “We wanted to find out whether the pandemic caused excess deaths in the countries we covered and, if so, to what extent.”

The impact of COVID-19 on a given country is usually assessed via the number of cases and the number of deaths, two statistics that have been reported daily by each country and put together into international dashboards such as the ones maintained by the World Health Organization or by the Johns Hopkins University in Maryland, they wrote. “However, both metrics can be heavily affected by limited testing availability and by different definitions of ‘COVID-19 death’ used by different countries: for example, some countries count only PCR-confirmed COVID-19 deaths, while others include suspected COVID-19 deaths as well.

To get more accurate figures, the team compared the number of overall “known deaths” during the COVID pandemic with the number of overall deaths from previous years.  In this way, they were able to determine the likely number of excess deaths caused by the coronavirus pandemic.  “Even though the number of excess deaths does not exactly equal the mortality rate from COVID-19 infections, for many countries it is the most objective indicator of their pandemic death toll,” Karlinsky noted.  

For example, several Latin American countries – Bolivia, Ecuador, Mexico and Peru – underreported their COVID-19 deaths even though the number of excess deaths sustained during the pandemic period was over 50% higher than the number of expected deaths. 

According to Karlinsky and Kobak’s World Mortality Dataset, Bolivia’s true number of COVID deaths is likely 2.5 times higher than they reported – 36,000 deaths instead of 15,000. In Ecuador, it’s 2.9 times higher – 64,000 deaths instead of the 22,000 reported, while in Mexico, the figure is 2.1 times higher – 471,000 instead of the 221,000 pandemic deaths that were reported.  

However, Peru stood out from these South American countries.  It originally underreported their COVID-19 deaths – claiming only 69,000 deaths when in fact, the real figure was closer to 185,000.  After an outcry by public health officials, Peru’s health ministry audited all deaths during the pandemic period and resubmitted COVID-19 mortality statistics to the World Health Organization that more accurately reflect the true number of excess deaths caused by the pandemic. 

Meanwhile, other countries have obstinately continued to underreport their COVID-19 deaths. The true number of pandemic deaths sustained by Russia (led by Vladimir Putin, whose country doesn’t have a reputation of always being truthful) is probably four times higher than reported – 551,000 deaths instead of 135,000.  

In Belarus that number is 14.5 times higher – 5,700 deaths, instead of 392, and in Uzbekistan 29 times higher – 21,500 deaths, instead of the 740 reported. Tajikistan wins the underreporting prize with a COVID-19 death rate that is whopping 100-times higher than reported – 9,000 deaths, instead of 90.  

The former Soviet Union is not alone in vastly underreporting its COVID-19 deaths.  According to the Karlinsky-Kobak study, Nicaragua’s true number of pandemic deaths is 50 times higher than reported – 7,000 coronavirus deaths instead of the 137 reported.  

However, it’s not all doom and gloom. Australia and New Zealand’s death rate during the pandemic was actually lower than previous periods. This is likely due to their virus-containment efforts that included border closures, social distancing and mask-wearing, which decreased their overall number of deaths during the pandemic.  

Among European nations, the team found that many countries faithfully reported their pandemic deaths.  Per 100,000 people, the United Kingdom suffered 159 deaths, France 110, Switzerland 100. The Czech Republic suffered 320 pandemic deaths and Poland 310.  Denmark and Norway were unique in that they experienced no excess mortality during the pandemic.  The US had 194 excess deaths per 100,000 persons.

In the Middle East, Israel’s excess deaths during the coronavirus pandemic were actually smaller than their reported figures – 5,000 instead of 6,400, as reported.  This is likely due to a decrease in the overall number of deaths from non-COVID 19 respiratory infections during the winter months.  At 58 excess deaths per 100,000 persons, Israel fared better than its neighboring countries (which provided overall mortality data).  

But honesty does not exist throughout the Middle East. Egypt’s excess deaths were 13 times higher than reported – 196,000 instead of 15,000; Iran’s were 2.15 times higher – 115,000 COVID-19 deaths instead of 54,000; and Lebanon’s figures were 1.23 times higher than reported—9,000 deaths instead of 7,300.  

“Our results present a comprehensive picture of the impact of COVID-19,” Kobak concluded.  “We hope these findings and their methodology will lead to a better understanding of the pandemic and highlight the importance of open-source and fast mortality reporting.”

When analyzing the overall figures, Karlinsky shared his hope, “that our dataset will be a valuable asset for public health officials looking to assess the risks and benefits of a given pandemic-containment measure.  Kobak and I are constantly expanding our dataset and will continue to track excess mortality around the world for the remainder of the COVID-19 pandemic”.