PT  - JOURNAL ARTICLE
AU  - Kung, Stacey
AU  - Doppen, Marjan
AU  - Black, Melissa
AU  - Braithwaite, Irene
AU  - Kearns, Ciléin
AU  - Weatherall, Mark
AU  - Beasley, Richard
AU  - Kearns, Nethmi
TI  - Underestimation of COVID-19 mortality during the pandemic
AID  - 10.1183/23120541.00766-2020
DP  - 2020 Jan 01
TA  - ERJ Open Research
PG  - 00766-2020
4099  - http://openres.ersjournals.com/content/early/2020/11/26/23120541.00766-2020.short
4100  - http://openres.ersjournals.com/content/early/2020/11/26/23120541.00766-2020.full
AB  - Background There has been considerable international variation in mortality during the COVID-19 pandemic. The objective of this study was to investigate the differences between mortality registered as due to COVID-19 and the excess all-cause mortality reported in countries worldwide during the COVID-19 pandemic.Methods Ecological analysis of 22 countries compared five-year historical all-cause mortality, reported all-cause mortality and expected all-cause mortality (calculated as the historical mortality plus the reported deaths attributed to COVID-19). Data available from the first week of January 2020 to that most recently available were analysed.Results Compared to the preceding five years, there was an excess of 716 616 deaths of which 64.3% were attributed to COVID-19. The proportion of deaths registered as COVID-19 related/excess deaths varied markedly between countries, ranging between 30% and 197% in those countries that had an excess of deaths during the period of observation. In most countries where a definite peak in COVID-19 related deaths occurred, the increase in reported all-cause mortality preceded the increase in COVID-19 reported mortality. During the latter period of observation, a few countries reported fewer all-cause deaths than the historical figures.Conclusion The increases in all-cause mortality preceded the increase in COVID-19 mortality in most countries that had definite spikes in COVID-19 mortality. The number of deaths attributed to COVID-19 was underestimated by at least 35%. Together these findings suggest that calculation of excess all-cause mortality is a better predictor of COVID-19 mortality than the reported rates, in those countries experiencing definite increases in mortality.