In the developing world, the true cost of Covid may never be known

Just how many lives have we lost to Covid-19? In large parts of the world, that is a question to which we may never get an answer. Officially, as of August 2021, the global death toll from the pandemic stands at approximately, 4.2 million. Most experts consider this to be a severe undercount.

Take India, the world’s second most populous country, whose healthcare system effectively collapsed in late spring. Thus far, it has recorded some 425,000 deaths, a terrible figure, yet still lower (on a per capita basis) than several of its Western counterparts. Are we really to believe that this relatively poor, densely populated country whose hospitals famously ran out of oxygen has suffered a lower death rate than Canada, France or the United States?

To that effect, some researchers estimate that India could have undercounted its Covid fatalities by seven or eight times, with the true death toll between 3.1 and 3.4 million. If true, this alone would double global Covid deaths for 2021.

While India is the most glaring example, many other countries have a similarly bleak story to tell. Late last year, the Russian government published a revised figure for its own death toll, three times higher than originally claimed. As the country battles a third wave of the virus, the official tally consistently falls far below excess mortality.

Meanwhile, few can honestly trust any of the figures coming out of China. The country where Covid-19 was first discovered, or potentially manufactured, has claimed to have virtually eliminated the disease. Officially recorded deaths remain below five thousand, with new weekly cases reported to be in the mere hundreds.

This would be a remarkable achievement for the world’s most populous country, yet outside observers have no way to verify such facts. From the onset of the pandemic, the Chinese government has worked tirelessly to conceal potentially embarrassing information. If the reality on the ground is substantially worse than is officially let on, we cannot reasonably expect Beijing to tell us.

While the likes of China are likely undercounting fatalities as a matter of policy, most developing countries simply do not posses to means to accurately gather data on the pandemic. Consider Central Asia. In Kyrgyzstan, recorded fatalities are at approximately two thousand. In terms of deaths per 100,000 people, this is substantially lower than just about anywhere in Western Europe. It is a similar story in Kazakhstan, which has recorded nine thousand deaths, or Tajikistan, where that number is apparently fewer than two hundred.

To a casual observer, it may seem strange that the countries which have reportedly suffered the most from the pandemic are, by and large, those which have the world’s most sophisticated and best funded healthcare systems. A peculiar virus this would be, one which prefers to infect the rich. Of course, where there is very little testing, people simply die, and their deaths are either attributed to other causes or are not counted at all.

Over the past year, researchers worldwide have attempted to calculate the true cost of the pandemic, mostly by using excess mortality. The World Health Organization (WHO) estimates that global Covid deaths numbered at least 3.0 million in 2020, in contrast to the 1.8 million officially recorded. However, even that is likely an undercount, as it concerns only countries in Europe and the Americas. In other parts of the world, there just was not enough data to make serious calculations.

As the WHO notes, this presents a serious problem. Without accurate data, “We cannot accurately measure the impact of the COVID-19 pandemic to better inform public policy and prepare for future health emergencies”. Furthermore, as developed countries finally get their own outbreaks under control, their attention will hopefully turn to global relief efforts. However, effectively delivering aid, such as vaccine doses, ventilators and other critical supplies, without knowing for sure where they are most needed, will pose a real challenge.