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Estimating the True Death Toll of COVID-19

Medically reviewed by Regina Victoria Boyles, MD · Pediatrics

Written by Lennie Daluz · Updated Feb 12, 2023

    Estimating the True Death Toll of COVID-19

    In some parts of the world, the COVID death rate has been in steady decline with the introduction and continuous efforts of vaccination. However, there have been many casualties in this fight against an unseen enemy. As of  October 16, 2021, the World Health Organization reported that over 4.8 million individuals worldwide have died of COVID.

    An important keyword here is “reported” because there are many more individuals who died of COVID who did not receive testing. And as a result, they do not appear in the official statistics. The Economist estimates that the number of excess deaths due to COVID is at least three to four times higher than reported — a staggering 10 to 20 million. 

    What Does the Data Tell Us?

    Gathering known data from the World Health Organization, one can see that most of the deaths recorded across different countries in the world occurred in the West (the Americas and Europe) with South-East Asia right behind them.

    The United States alone had over 44.4 million recorded cases and 724,000 deaths in 2021. Case fatality rate (CFR) is a measure of health that refers to how many people died out of all who got the disease. Thus, using these official numbers for the US, their average COVID-19 case fatality rate was around 1.6% at that time.

    Comparing that to the Philippines in Southeast Asia, where there were over 2.2 million cumulative cases and 42,000 deaths in that same year, the average case fatality then was at 1.9%. 

    Does the low CFR mean that both countries are handling the pandemic well? Unfortunately not. One of the limitations of using the case fatality rate is the fact that it is only computed for confirmed cases and confirmed deaths due to a particular disease. To be able to consider the COVID death rate as completely accurate, COVID-19 testing must have been done on everyone. As the past years have shown, testing everyone, especially in low-resource settings, was neither practical nor useful. 

    The Impact of a Nation’s Health System

    Improvements in health system capabilities for the U.S., as well as previous travel restrictions, kept the COVID death rate relatively low. Spikes did occur during the reopening of industries in 2020. Although this part of the world had seen increased cases from the easing of restrictions, the death rates remain low. This is likely due to extensive and continuous vaccination efforts since December 2020, until present.

    Travel and movement restrictions have eased up in the Philippines. Widespread vaccination began in March 2021 and is continuously carried on up to date. And the health system is less overwhelmed and Covid 19 cases have been much lower than in some countries. 

    What Does the Data Not Tell Us?

    The fact is that testing rates for the Philippines and other low- and middle-income countries remain low. In many places, this is mainly because testing remains expensive and still inaccessible to the public. Thus, the capacity for testing is the first important factor in considering the true death toll of COVID-19. When many people die without testing, this can cause an underestimation of the true CFR. 

    The second important consideration for tallying the true COVID death rate are cases that were never confirmed with testing who died while in line for admission to hospitals. So many health systems have experienced to be just one big spike away from total collapse. Health workers have been exhausted, resources became inadequate, and facilities have not been able to accommodate everyone then.

    What About Everyone Else Who Died?

    Another important aspect to consider when computing the COVID death rate is everything non-COVID. Many patients who had conditions other than COVID were turned away from hospitals due to lack of facilities or human resources to care for them. Other sick people chose to die in their homes for fear of exposure to COVID-19. And many people had no access to care because of redeployment of health workers and resources to places with a high COVID death rate. 

    In a way, it can be argued that these people also died “because of COVID.” However, it is hard to ascertain how many of them would still have died if the pandemic never happened. Taking all of these into consideration, the 10 to 20 million deaths due to COVID estimated by The Economist does not seem too far-fetched.

    Key Takeaway

    The pandemic continues to ravage the globe and has claimed countless lives. It has caused deaths directly through COVID-19 infections and complications. And it also causes more deaths indirectly through other diseases that were not a priority in the pandemic.

    It is imperative that the nations of the world come together to defeat this threat. As the WHO put it, “None of us will be safe until everyone is safe.”

    Learn more about COVID-19 here.


    Hello Health Group does not provide medical advice, diagnosis or treatment.

    Medically reviewed by

    Regina Victoria Boyles, MD


    Written by Lennie Daluz · Updated Feb 12, 2023

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