The World Health Organisation's much anticipated and contested report on excess deaths associated with COVID between January 2020 to December 2021 revealed that India with an estimated 4.7 million excess deaths has the highest number of deaths globally. This number aligns with the approximate number of excess deaths that the New York Times and Devex reported but India refuted these numbers.
Earlier in April, when the New York Times article was published, the Ministry of Health and Family Welfare issued a statement denouncing the methodology used by the WHO to calculate the deaths. The government said that the technical advisory group of the health organisation took into consideration models and predicted results which do not show the true picture in the country. India has so far reported only 5.2 lakh COVID deaths.
In another statement issued following the release of the report, the health ministry said that they still do not adhere with the methodology followed by the WHO. Instead, the Ministry wanted the WHO to rely on data from the Central Registration System that covers deaths that occurred in India in 2020.
India was against the use of mathematical models in estimating excessive mortality. The country is also not happy that the WHO put India into a tier II category for estimating the deaths. The Indian government also felt that the report disregarded India's varied COVID-19 test positivity, its demography, and geography.
India objected to the use of Global Health Estimates (GHE) 2019, which is an estimate itself, in one of the models used by WHO for calculating excess mortality estimates for India.
BOOM went through the WHO database and found that the WHO predicted death values only for the last three months of 2021 and not for the other 21 months that were assessed.
According to the WHO website, 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. Thus, the WHO included counted as well as uncounted deaths directly attributable to COVID , deaths due to other diseases, and even death that could have occurred if there were no social restrictions or lockdowns such as road traffic accidents.
What Else Does The Report Say?
The report also stated that the global total of excess deaths is close to 14.9 million which is three times the reported number. The report showed that along with India, many other countries had not reported or counted their COVID deaths. Some of these countries include Egypt with over 2.5 lakh excess deaths, Brazil with 6.6 lakh excess deaths, Indonesia with 1.02 million excess deaths, and Russia with over 1.07 million excess deaths.
The report highlighted that about 84% of the excess deaths were concentrated in South-East Asia, Europe, and the Americas. Additionally, the WHO also found that about 68% of the excess deaths were predominantly from just 10 countries globally.
An age and sex wise division showed that more men died due to the pandemic than females (57% male, 43% female). The age division was skewed toward older adults being infected and succumbing to the virus.
How Did WHO Calculate Excess Mortality?
The WHO has used various methods to calculate the excess death estimates. They have combined national data on reported deaths from the respective countries along with new information from localities and household surveys, and statistical modelling to account for deaths that were missed. The difference in the new global estimates mostly represents deaths that were previously uncounted both from COVID as well as indirect deaths such as people who lost their lives because they were unable to access care for other diseases due to the ongoing pandemic.
The calculations also take into account expected deaths that did not occur because of Covid restrictions, such as those from traffic accidents. Excess mortality here suggests the difference between all deaths that occurred and those that would have been expected to occur under normal circumstances.
Dr Samira Asma, Assistant Director-General for Data, Analytics and Delivery at WHO in a press release said that measurement of excess mortality was an essential component to understand the impact of the pandemic.
"Shifts in mortality trends provide decision-makers information to guide policies to reduce mortality and effectively prevent future crises. Because of limited investments in data systems in many countries, the true extent of excess mortality often remains hidden," Dr. Asma said .
She even added that these new estimates used the best available data and followed a completely transparent approach along with robust methodology.