TY - JOUR T1 - Underestimation of COVID-19 mortality during the pandemic JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00766-2020 VL - 7 IS - 1 SP - 00766-2020 AU - Stacey Kung AU - Marjan Doppen AU - Melissa Black AU - Irene Braithwaite AU - Ciléin Kearns AU - Mark Weatherall AU - Richard Beasley AU - Nethmi Kearns Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/7/1/00766-2020.abstract N2 - 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 5-year historical all-cause mortality, reported all-cause mortality and expected all-cause mortality (calculated as 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 5 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.In countries experiencing marked increases in all-cause mortality during the global pandemic, all-cause mortality more accurately estimates #COVID19 mortality and the onset of the pandemic than the reported COVID-19 mortality rates https://bit.ly/3fOtBJg ER -