The true death toll of COVID

Two articles I have noticed about this:   one in Nature that starts:

On 1 November, the global death toll from the COVID-19 pandemic passed 5 million, official data suggested. It has now reached 5.5 million. But that figure is a significant underestimate. Records of excess mortality — a metric that involves comparing all deaths recorded with those expected to occur — show many more people than this have died in the pandemic.

Working out how many more is a complex research challenge. It is not as simple as just counting up each country’s excess mortality figures. Some official data in this regard are flawed, scientists have found. And more than 100 countries do not collect reliable statistics on expected or actual deaths at all, or do not release them in a timely manner.

And after explaining the complexities, concludes with this:

Amid the search for ways to count deaths, Andrew Noymer, a demographer at the University of California, Irvine, says the pandemic and the increased demand for real-time mortality figures highlight a demographic shortcoming that goes back decades: many countries simply don’t collect good data on births, deaths and other vital statistics. “Demographers have been part of the problem, because we have helped to put band-aids on this for 60 years. We’ve developed all sorts of techniques to estimate demographic rates in the absence of hard data,” he says.

That means the true death toll of COVID-19 might always be disputed. “We still don’t know how many people died in the 1918 [flu] pandemic, but I always figured we would know pretty well how many people would die in the next one, because we live in the modern world,” Noymer says. “But we don’t actually, and that’s kind of sad for me as a demographer.”

Over at Science, the particular difficulties of counting deaths in India is discussed in detail in a paper.  (I have always said that I would not be surprised if the true death rate effect of heat waves in that country was not clear at all.)   Here's the abstract:

India’s national COVID death totals remain undetermined. Using an independent nationally representative survey of 0.14 million (M) adults, we compared COVID mortality during the 2020 and 2021 viral waves to expected all-cause mortality. COVID constituted 29% (95%CI 28-31%) of deaths from June 2020-July 2021, corresponding to 3.2M (3.1-3.4) deaths, of which 2.7M (2.6-2.9) occurred in April-July 2021 (when COVID doubled all-cause mortality). A sub-survey of 57,000 adults showed similar temporal increases in mortality with COVID and non-COVID deaths peaking similarly. Two government data sources found that, when compared to pre-pandemic periods, all-cause mortality was 27% (23-32%) higher in 0.2M health facilities and 26% (21-31%) higher in civil registration deaths in ten states; both increases occurred mostly in 2021. The analyses find that India’s cumulative COVID deaths by September 2021 were 6-7 times higher than reported officially.