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BU professor: True death toll of COVID-19 pandemic could now be as high as 1.22 million in United States

A Boston University professor estimated Thursday that the death toll from the COVID-19 pandemic in the United States could now be as high as 1.22 million, substantially higher than the nearly 1 million that official counts are approaching.

“We passed the million mark some time ago,” said Andrew C. Stokes, an assistant professor in the Department of Global Health at the Boston University School of Public Health.

He said the additional deaths in his count reflected deaths from COVID-19 that were not recorded due to “pervasive underreporting,” as well as deaths caused by “indirect mechanisms” such as interruptions in health care, people delaying care, and economic hardship and food insecurity.


The US Centers for Disease Control and Prevention estimates that the country will reach an official count of 1 million COVID-19 deaths within a couple of weeks. NBC News reported Wednesday, based on its own data, that the country had edged over that mark.

Stokes based his estimate on research he and colleagues from BU, the University of Pennsylvania, and the Robert Wood Johnson Foundation have done on excess mortality caused by the pandemic.

In a preprint study released this week, they looked at 3,127 US counties (all of them except for 15 that had data issues) and found that from March 2020 to this past December, 936,911 more deaths occurred than were expected, including 171,168 deaths that were not assigned to COVID-19 on death certificates.

“Deaths during the Covid-19 pandemic have been primarily monitored through death certificates containing reference to Covid-19. This approach has missed more than 170,000 deaths related to the pandemic between 2020 and 2021,” the study said.

Stokes said that, based on that work, a “back of the envelope” calculation would suggest that, as of today, the current number of excess deaths has reached 1.2 million.


The study emphasized that it’s important that deaths not be undercounted. “Discrepancies between Covid-19 death rates and excess death rates are problematic because they have the potential to mislead scientists and policymakers about which areas were most heavily affected during the pandemic. Failure to accurately capture Covid-19 deaths also points to an urgent need to modernize the death investigation system in the United States,” it said.

“Undercounts may also distort individual risk perceptions, leading to lower vaccine uptake and less masking/social distancing,” Stokes also pointed out in a series of tweets Thursday.

Stokes noted that misclassifying a COVID-19 death can have a financial impact on people, too. People who lose a loved one to COVID-19 are eligible for thousands of dollars in funeral aid from the Federal Emergency Management Agency. They can’t get it if the death isn’t classified correctly.

“As Covid-19 surveillance is phased out and more testing occurs at home via rapid tests, Covid-19 death tallies may become even more inaccurate. Excess mortality will continue to be an important tool for monitoring the impact of the pandemic,” Stokes tweeted.

The BU-led study comes as an expert panel assembled by the World Health Organization reported Thursday that overall roughly 14.9 million more people worldwide died in 2020 and 2021 than would have been expected in normal times, far more than the official death count of 6 million.

The WHO came up with a similar number of excess deaths for the United States as the BU researchers did, estimating around 932,000 excess deaths directly or indirectly associated with the pandemic in 2020 and 2021.


The WHO said some other countries’ numbers were much further from reality than the US numbers. Nearly a third of the excess deaths globally — 4.7 million — took place in India, for example, according to the WHO estimates. The Indian government’s figure through the end of 2021 is 481,080 deaths.

“It’s absolutely staggering what has happened with this pandemic, including our inability to accurately monitor it,” said Dr. Prabhat Jha, a public health researcher at St. Michael’s Hospital and the University of Toronto, who was a member of the expert working group that made the calculations. “It shouldn’t happen in the 21st century.”

Material from Globe wire services was used in this report.

Martin Finucane can be reached at