Moeti M, Makubalo L, Gueye AS, Balde T, Karamagi H, Awandare G, Thumbi SM, Zhang F, Mutapi F, Woolhouse M. Conflicting COVID-19 excess mortality estimates. The Lancet. 401(10375). https://doi.org/10.1016/S0140-6736(23)00112-5
A study1 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 underreporting 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.2 We note the modelling approach in the study1 assumes a homogeneous Africa, well represented by a few, atypical locations, leading to unreliable out-ofsample 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.