The number of people who have died from Covid-19 has exceeded 1 million, according to a tally of cases maintained by Johns Hopkins University, with no sign the global death rate is slowing and infections on the rise again in countries that were thought to be controlling their outbreaks months ago.
The milestone was reached early on Tuesday morning UK time, nine months since authorities in China first announced the detection of a cluster of pneumonia cases with an unknown cause in the central Chinese city of Wuhan. The first recorded death, that of a 61-year-old man in a hospital in the city, came 12 days later.
So far there have been 1,000,555 deaths from Covid-19, according to the latest update to the database, which draws on information from the World Health Organization, the US and European centres for disease prevention and control and China’s national health authority, among other sources.
But the official figure probably underestimates the true total, a senior World Health Organization official said on Monday.
“If anything, the numbers currently reported probably represent an underestimate of those individuals who have either contracted Covid-19 or died as a cause of it,” Mike Ryan, the WHO’s top emergencies expert, told a briefing in Geneva.
“When you count anything, you can’t count it perfectly but I can assure you that the current numbers are likely an underestimate of the true toll of Covid.”
More than one-fifth of the tallied deaths have occurred in the US, the most of any country in the world, followed by more than 142,000 in Brazil and more than 95,000 in India, which is currently recording the most new cases per day.
The figure is only the known toll of a virus that may have already been spreading in the world, and killing people, before it was first identified in China in December. Studies from Italy have found traces of the virus in sewage samples taken the same month, while scientists in France have identified a case there on 27 December.
There is thought to be significant underreporting of deaths in many countries including Syria and Iran, either for political reasons or due to lack of capacity. Some countries report anyone who died with Covid-19 as a death from the virus, even if it is not thought to have been the direct cause, while even in developed countries, deaths from Covid-19 in the home may be less likely to be counted than those in hospitals.
“To some extent the quest for the true number of Covid-19 deaths is impossible,” said Gianluca Baio, a professor of statistics and health economics at University College London.
It might also not be so meaningful, he added. “The million figure is indicating a tragedy, it tells us a lot of people have died. But what’s crucial is not so much the actual number.
“The point is how many people have died from Covid-19 whose lives could have been extended. That’s the real number we have to investigate and come out on the other side of this pandemic with.”
Establishing the excess mortality figure would likely come much later, after the acute stage of the pandemic has ended and data could be collected and cleaned of as much uncertainty as possible, said Marta Blangiardo, a professor of biostatistics at Imperial College London.
“It is when all this information about cause-specific deaths becomes available, which can be months and months after the main event, that you can go back and try to disentangle the numbers.”
A study published on pre-print servers in July and yet to undergo peer review estimated 202,900 extra deaths across 17 countries between mid-February and the end of May, most in England, Wales, Italy and Spain. The confirmed global toll over the same period was fewer than 100,000 deaths.
Despite its imperfections, the recorded death count still paints a picture of a pandemic that escalated with astonishing speed from February and has not relented.
There were still fewer than 100 confirmed deaths per day at the beginning of March, mostly in China, the Johns Hopkins database shows. Over the following weeks rates appeared to explode in countries such as Spain, Italy and Iran, and throughout April an average of 6,400 deaths were being recorded around the world every day.
The fewest deaths per day since then were recorded in May with an average of 4,449 deaths and August the heaviest toll with 5,652 daily fatalities.
Evidence of long-term heart, lung and other issues among Covid-19 survivors is growing, but future estimates of the virus’s deadliness have fallen since the beginning of the outbreak, and would likely continue to do so, said Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh.
“Almost invariably in the early stages of a pandemic, we overestimate, often by a lot, the ration of deaths to cases. We simply weren’t detecting [the mild cases]. We were seeing the tip of the iceberg, and it was the tip of the iceberg with the deaths in it.”
It was increasingly clear that fatalities from the virus “are hugely concentrated in a subset of 10 to 20% of the population: the elderly, frail and those with co-morbidities”, he said.
“Among that population the case fatality rate is much higher than the initial WHO estimate. It’s really high, but for the rest of the population it’s much lower. It’s down to what we might expect from an influenza, or even lower than that.”
A senior WHO official said last week that without concerted action to fight the virus the prospect of the death toll eventually reaching 2m was “very likely” before a vaccine was widely distributed.