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- W4319660759 abstract "A study1COVID-19 Excess Mortality CollaboratorsEstimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21.Lancet. 2022; 399: 1513-1536Summary Full Text Full Text PDF PubMed Scopus (222) Google Scholar by the COVID-19 Excess Mortality Collaborators estimates more than 18 million COVID-19 deaths globally by the end of 2021—three times those reported. The COVID-19 Excess Mortality Collaborators claim that under-ascertainment is especially severe in sub-Saharan Africa, with actual deaths 14 times higher than the 150 000 reported—more than 2 million excess deaths across the region in 2020–21. Although we welcome efforts to quantify the burden of the pandemic, we consider this level of under-reporting of deaths implausible. There is no evidence of such a huge death toll and COVID-19 particularly affected large cities where spikes in the mortality rate would be readily visible.2Zhang F Karamagi H Nsenga N et al.Predictors of COVID-19 epidemics in countries of the World Health Organization African region.Nat Med. 2021; 27: 2041-2047Crossref PubMed Scopus (16) Google Scholar We note the modelling approach in the study1COVID-19 Excess Mortality CollaboratorsEstimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21.Lancet. 2022; 399: 1513-1536Summary Full Text Full Text PDF PubMed Scopus (222) Google Scholar assumes a homogeneous Africa, well represented by a few, atypical locations, leading to unreliable out-of-sample extrapolations. For example, the estimates for Kenya equate to an increase of more than 50% from a baseline of 280 000 deaths annually and imply that a country with alert health services and a mandatory death registration system identified only 3% of COVID-19-related deaths. Although the COVID-19 pandemic has undoubtedly been a substantial public health problem in Africa, no regional estimates suggest such a high death toll.3Cabore JW Karamagi HC Kipruto H et al.The potential effects of widespread community transmission of SARS-CoV-2 infection in the World Health Organization African region: a predictive model.BMJ Glob Health. 2020; 5: e002647Crossref PubMed Scopus (60) Google Scholar The WHO African region's own estimates suggest a seroprevalence of more than 50% and 430 000 COVID-19 deaths, corresponding to one in three deaths being reported in 2020–21,4Cabore JW Karamagi HC Kipruto HK et al.COVID-19 in the 47 countries of the WHO African region: a modelling analysis of past trends and future patterns.Lancet Glob Health. 2022; 10: e1099-e1114Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar an under-reporting rate comparable with the rest of the world. The focus should be on understanding the mechanisms responsible for this outcome,5Mbow M Lell B Jochems SP et al.COVID-19 in Africa: dampening the storm?.Science. 2020; 369: 624-626Crossref PubMed Scopus (92) Google Scholar rather than creating narratives suggesting that African health authorities were uniquely incompetent. We declare no competing interests. Conflicting COVID-19 excess mortality estimates – Authors' replyThe COVID-19 pandemic has caused almost 8 million reported deaths worldwide since late 2019.1 Although this is a staggering loss of human lives, 8 million is a vast under-estimation of the true toll of the pandemic. In addition to under-reporting and misclassification of COVID-19 deaths, the pandemic has also resulted in loss of lives due to stressed health-care systems. Excess mortality due to the COVID-19 pandemic, a measurement of net changes in all-cause mortality during the pandemic compared with levels before the pandemic, is widely considered the best measurement of the overall effect of the pandemic and is increasingly a metric used to compare country performance with expectations. Full-Text PDF Conflicting COVID-19 excess mortality estimatesThe COVID-19 Excess Mortality Collaborators concluded that “The full impact of the pandemic has been much greater than what is indicated by reported deaths due to COVID-19 alone”. They estimate that 18·2 million (95% CI 17·1–19·6) people died worldwide because of the pandemic (as measured by excess mortality) in 2020–21, instead of the reported COVID-19 deaths of 5·94 million worldwide during that period, as WHO claims. Full-Text PDF Conflicting COVID-19 excess mortality estimatesExcess mortality is an important metric summarising COVID-19 disease burden, informing public health policy and future preparedness needs.1 However, separating the deaths that occurred from COVID-19 versus those from all other causes is challenging. Essentially, the unknowns are the counterfactual, should an infection wave not have happened. A solution to this challenge is to estimate expected number of individuals who would have died and compare this with the observed number of deaths. The estimation of expected number of deaths must consider changes in population and seasonal dynamics and be based on an appropriate reference period. Full-Text PDF Conflicting COVID-19 excess mortality estimatesAlthough the global review of excess deaths from the COVID-19 pandemic might seem to give authorities in some countries encouragement for their policies,1 it seems unfortunate that a key vulnerable group was missing from discussion in the paper. Full-Text PDF Conflicting COVID-19 excess mortality estimatesTo estimate the COVID-19 death toll, the COVID-19 Excess Mortality Collaborators1 have presented excess mortality estimates for 2020–21 for all countries in the world. We argue that for many countries, these estimates are implausible because they imply an unrealistic number of expected deaths, inconsistent with trends before the pandemic. A case in point is Japan, where the authors estimated 111 000 (95% CI 103 000–116 000) excess deaths from Jan 1, 2020, to Dec 31, 2021—an order of magnitude higher than the estimate by The Economist2 (12 000) and qualitatively different from the World Mortality Dataset's3 negative estimate (–13 100). Full-Text PDF Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21The full impact of the pandemic has been much greater than what is indicated by reported deaths due to COVID-19 alone. Strengthening death registration systems around the world, long understood to be crucial to global public health strategy, is necessary for improved monitoring of this pandemic and future pandemics. In addition, further research is warranted to help distinguish the proportion of excess mortality that was directly caused by SARS-CoV-2 infection and the changes in causes of death as an indirect consequence of the pandemic. 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- W4319660759 title "Conflicting COVID-19 excess mortality estimates" @default.
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