What is the real number of deaths due to Covid-19?

There are 3.5 million reported deaths globally due to Covid-19 and Pakistan has reached a grievous milestone of 20,000. This figure included two close friends of mine — both medical doctors. For most of us, statistics are just numbers we read daily and ignore but behind each number is a human life and a family’s future. Epidemics have ravaged regions before. Just recently, Ebola had ravaged health systems in some African countries by killing 7% of healthcare workers.

Just like any war, where intelligence could make you win or lose, we also need good health intelligence in a pandemic. For us disease detectives, accurate numbers are like pieces of a huge jigsaw puzzle. If we do not have most of the pieces, it will be difficult to complete the puzzle and understand the bigger picture. Knowing accurate numbers helps in effective decision making and resource allocations especially in the time of a major health crisis like this pandemic.

The problem with numbers has been multifold. Many countries do not have good disease surveillance systems. Some countries actively manipulate their disease numbers. This manipulation is sometimes at the central level, and at times local districts are doing this, to not be blamed for an increase in cases. Some countries are not doing enough testing and following the mantra that “ignorance is bliss”.

But you cannot hide dead bodies! Actually, you can, but eventually the truth surfaces along riverbanks, or drone photos of mass graves or freshly dug graves. From the start of the pandemic, experts are trying to gauge the level of “excess” deaths due to Covid-19 in different countries. In a recent study published in the British Medical Journal, which looked at 27 high income countries, it estimated that the US under-reported nearly 450,000 deaths. In another study which looked at excess mortality in different US counties, it saw more unreported deaths in areas inhabited by minorities and the poor. The International Health Metrics and Evaluation (IHME) has estimated that actual deaths due to Covid-19 could be easily two to three times the reported numbers. It could be more than 700,000 (reported 250,000) in India, 600,000 (220,000 reported) in Mexico, and over 600,000 against the 110,000 reported in Russia. Egypt is estimated to have 175,000 deaths compared to the 14,000 reported. IHME uses an extraordinarily system to ascertain different local disease burden estimates and country data to come up with these numbers.

But what about Pakistan? To start with we do not even have vital statistics (accurate birth and death registers) which is considered a basic building block for any later reliable statistics. That shows the importance our leaders give to the most valuable indicator not only for health but even for economy and education. That lack of respect of numbers then reflects in badly executed projects and resource allocations. IHME just mentions that Covid-19 is the third leading cause of death for Pakistan and actual deaths could be a multiple of reported deaths.

True numbers are never an enemy of any government. Instead, they help governments quickly identify and effectively control problems. With less accurate numbers, both governments and the public suffer. It’s not enough for a country to not hide its numbers, it’s important to accurately collect disease numbers. A good disease surveillance system is essential and we now need a health intelligence system. With each death reported or unreported, there is a human being and a family that is suffering. Statistics are not just numbers but influence our lives too.