36,000 Missing Deaths: Tracking the True Toll of the Coronavirus Crisis

At least 36,000 more people have died during the coronavirus pandemic over the last month than the official Covid-19 death counts report, a review of mortality data in 12 countries shows — providing a clearer, if still incomplete, picture of the toll of the crisis.

In the last month, far more people died in these countries than in previous years, The New York Times found. The totals include deaths from Covid-19 as well as those from other causes, likely including people who could not be treated as hospitals became overwhelmed.

Note: Excess deaths are estimates that include deaths from Covid-19 and other causes. Reported Covid-19 deaths reflect official coronavirus deaths during the period when all-cause mortality data is available, including figures that were later revised. Istanbul reported deaths include those for all of Turkey.
These numbers undermine the notion that many people who have died from the virus may soon have died anyway. In Paris, more than twice the usual number of people have died each day, far more than the peak of a bad flu season. In New York City, the number is now four times the normal amount.

Of course, mortality data in the middle of a pandemic is not perfect. The disparities between the official death counts and the total rise in deaths most likely reflect limited testing for the virus, rather than intentional undercounting. Officially, about 190,000 people have died worldwide of the coronavirus as of Saturday.

But the total death numbers offer a more complete portrait of the pandemic, experts say, especially because most countries report only those Covid-19 deaths that occur in hospitals.

“Whatever number is reported on a given day is going to be a gross underestimate,” said Tim Riffe, a demographer at the Max Planck Institute for Demographic Research in Germany. “In a lot of places the pandemic has been going on for long enough that there has been sufficient time for late death registrations to come in, giving us a more accurate picture of what the mortality really was.”

Ecuador recorded about 7,600 more deaths than usual over the same period in the last three years — 15 times higher than the reported number of Covid-19 deaths in the country during the same period.

Deaths in Ecuador
7,600+ excess deaths from Mar. 1 to Apr. 15

Data as of April 15

7,500

monthly

deaths

2020

2019

Jan. – Apr.

5,000

2017-2019

monthly average

2,500

Jan.

Feb.

Mar.

Apr.

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

Sources: General Direction of Civil Registry; National Institute of Statistics
The differences are particularly stark in countries that have been slow to acknowledge the scope of the problem. In March, the Indonesian government attributed 84 deaths to the coronavirus in Jakarta. But over 1,600 people more than normal were buried in Jakarta cemeteries that month, according to data from the city’s Department of Parks and Cemeteries. (The data was first reported by Reuters.)

Number of burials reported in Jakarta, Indonesia
1,600+ excess burials reported in March

2020

4,000

monthly

burials

3,000

2,000

2010-2019

monthly average

1,000

Jan.

Feb.

Mar.

Apr.

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

Source: Jakarta Department of Parks and Cemeteries.
And in Istanbul, the city recorded about 2,100 more deaths than expected from March 9 through April 12 — roughly double the number of coronavirus deaths the government reported for the entire country in that period.

The increase in deaths in mid-March suggests that many people who died had been infected in February, weeks before Turkey officially acknowledged its first case.

Deaths in Istanbul
2,100+ excess deaths from Mar. 9 to Apr. 12

2020

2,000

weekly

deaths

2018-2019

weekly average

1,000

No data

Mar.

June

Sept.

Dec.

Source: Istanbul Metropolitan Municipality. | Note: Data for the first weeks are excluded, as they may represent partial weeks.
We estimated the excess mortality for each country by comparing the number of people who died from all causes this year with the historical average during the same period. The Economist is also tracking these deaths, known as excess deaths, in this way.

In many European countries, recent data show 20 to 30 percent more people have been dying than normal. That translates to tens of thousands of more deaths.

Spain

England & Wales

19,700+ excess deaths from Mar. 9 to Apr. 5

16,700+ excess deaths from Mar. 7 to Apr. 10

2020

15,000

weekly

deaths

15,000

weekly

deaths

5,000

2010-2019

weekly average

5,000

Mar.

June

Sept.

Dec.

Mar.

June

Sept.

Dec.

France

14,500+ excess deaths from Mar. 9 to Apr. 5

2020

15,000

weekly

deaths

2019

2010-2018

weekly average

5,000

Mar.

June

Sept.

Dec.

Notes: Data from weeks 1, 52 and 53 are excluded, as they may represent partial weeks.
In some countries, like Belgium and France, authorities are working to include Covid-19 deaths outside of hospitals in their daily reports, or by adjusting the overall Covid-19 death totals once a death is confirmed in places like nursing or retirement homes.

Others, like Britain’s Office for National Statistics, have started to release mortality data after death certificates have been processed, confirming those that mention Covid-19. This provides a more accurate account of mortality than the hospital figures released each day by Public Health England, however the data is delayed about two weeks.

Deviations from normal patterns of deaths have been confirmed in many European countries, according to data released by the European Mortality Monitoring Project, a research group that collects weekly mortality data from 24 European countries.

Netherlands

Belgium

4,000+ excess deaths from Mar. 9 to Apr. 5

2,300+ excess deaths from Mar. 9 to Apr. 5

2020

2020

4,000

weekly

deaths

3,000

weekly

deaths

2,000

1995-2019

weekly average

2015-2019

weekly average

1,000

Mar.

June

Sept.

Dec.

Mar.

June

Sept.

Dec.

Sweden

Switzerland

1,100+ excess deaths from Mar. 9 to Apr. 12

1,000+ excess deaths from Mar. 9 to Apr. 5

2020

2020

2,000

weekly

deaths

1,500

weekly

deaths

1,000

1,000

2015-2019

weekly average

2016-2019

weekly average

500

Mar.

June

Sept.

Dec.

Mar.

June

Sept.

Dec.

Notes: Data from weeks 1, 52 and 53 are excluded as they are incomplete in certain years.
It is unusual for mortality data to be released so quickly, demographers say, but many countries are working to provide more comprehensive and timely information because of the urgency of the coronavirus outbreak. The data is limited and, if anything, excess deaths are underestimated because not all deaths have been reported.

“At this stage, it’s a partial snapshot,” said Patrick Gerland, a demographer at the United Nations. “It’s one view of the problem that reflects that most acute side of the situation, primarily through the hospital-based system.”

That is likely to change.

“In the next couple of months,” Mr. Gerland said, “a much clearer picture will be possible.”

Age breakdowns in mortality data could provide an even clearer picture of the role of Covid-19 in excess deaths. In Sweden, for example, a high mortality rate among men age 80 and older accounted for the largest increase in deaths, suggesting that the overall numbers understate the severity of the outbreak for older people in particular.

Even taking into account the new numbers, experts say the death toll to date could have been much worse.

“Today’s rise in all-cause mortality takes place under conditions of extraordinary measures, such as social distancing, lockdowns, closed borders and increased medical care, at least some which have positive impacts,” said Vladimir Shkolnikov, a demographer at the Max Planck Institute for Demographic Research. “It is likely that without these measures, the current death toll would be even higher.”

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