Clara Ferreira Marques

We Need to Count the Pandemic’s Invisible Deaths

Eighteen months into the Covid-19 pandemic, we don’t know exactly how many people have died. A true global tally is not just overdue. It’s vital.

The task is a Herculean one, given that so much of the world struggles to record basic information about deaths even in normal times. But without a better grasp of the toll, we will strain to assess the precise, real-world impact of vaccines and other preventative measures, or to understand just how lethal variants have been. Absent efforts to fill the gaps even in developed nations, the wealthy will be counted, but too many of the rest will not, making it easy for economic recovery to overlook the underserved.

Deaths are a sure indicator of the damage wrought. The trouble is just how bad we are at counting them.

The World Health Organization puts the pandemic’s toll at more than 195 million infections and over 4 million deaths. Both anecdotal evidence and academic estimates suggest reality is far worse. That’s not necessarily because of deliberate misreporting, though there have certainly been instances of politically motivated lowballing. More commonly, it’s a combination of insufficient testing and patchy data collection, families’ reluctance to register coronavirus deaths to avoid funeral restrictions and stigma, and a narrow view of what counts as a Covid-19 fatality amid complications or confusion from underlying ailments. Probable coronavirus deaths that aren’t confirmed by a diagnostic test can also go unrecorded, despite global guidelines to the contrary.

Considering excess mortality — a measure that includes all fatalities above what would be expected in normal conditions, based on historic trends — gets around some of those issues and is arguably a better metric for the overall loss, capturing deaths from mental health strain, drug abuse, or illnesses left undiagnosed while hospitals were overwhelmed. It just isn’t necessarily any easier to track.

The developing world has gotten better at registering births, partly because of incentives or the need for families to provide legal identity to access schooling or other services. But still too many deaths are either not reported at all, or are recorded inadequately. Civil registration systems reflect the capacity of the states supporting them. Often they are slow and fragmentary, even for deaths in hospital. One Bangladesh study done outside the capital, Dhaka, found that out of all deaths in the households surveyed, only 17% were registered and most of those were men. Only 5% of female deaths made it into the record.