In Brief

By How Much Are Countries Underreporting COVID-19 Cases and Deaths?

As COVID-19 continues to ravage countries including Brazil and India, scientists warn that cases and deaths are being undercounted. Without accurate tallies, government responses won’t be enough to defeat outbreaks.

Is there a reckoning underway on COVID-19 data?

Data scientists studying the spread of COVID-19 have found that the magnitude of the pandemic appears to be greatly underreported. In some places, the disparity appears to be as many as hundreds of thousands of fatalities, according to researchers tracking a metric known as excess deaths—or the number of deaths over what was expected based on historical averages. Some epidemiologists say this is a more comprehensive way to capture the toll than official government counts, though experts note there are complications to this method as well. 

Why does it matter?

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Understating the caseload and death toll has real consequences for how a country responds. Governments could fail to direct funding and other resources to an area in need if the virus appears to be a relatively low threat there. 

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At the same time, erroneously low counts—due to a lack of testing or, in some cases, pressure or policies by government officials—can affect individual behavior. If people feel there is a low risk of contracting COVID-19 in their community, they could choose to interact more with others, which can drive up the overall caseload. 

Additionally, accurate tallies help provide scientists with critical information about the virus, including the fatality rate.

What does COVID-19 reporting look like across different countries?

Countries that have suffered some of the worst outbreaks offer snapshots of the challenges in getting accurate tallies, as well as the politics at play:

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An aerial view of a mass cremation of COVID-19 victims at a crematorium in New Delhi, India, on April 26, 2021.
A mass cremation of COVID-19 victims is seen at a crematorium in New Delhi, India, on April 26, 2021. Adnan Abidi/Reuters

India. In the midst of a devastating surge, the world’s second-most-populous country is losing close to four thousand people per day, according to health ministry data. But journalists and medical experts say there is massive underreporting, detailing accounts of supervisors instructing crematory workers not to list COVID-19 as the cause of death and local officials hounding labs to report fewer positive cases. Prime Minister Narendra Modi’s government is accused of downplaying the seriousness of the disease and failing to coordinate a national response that includes rigorous testing.

Brazil. The country has reported nearly fifteen million COVID-19 cases and over four hundred thousand deaths, accounting for 13 percent of the global death toll despite having just 3 percent of the world’s population. Still, analysts say that these totals are undercounts because of a lack of testing and the challenges of tracking COVID-19 deaths in the favelas of Rio de Janeiro and other cities, where millions of poor people live. Now, doctors warn that infant deaths from the virus are being severely underreported.

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Russia. Throughout the pandemic, Russia’s coronavirus task force has claimed extremely low fatalities compared to other countries, which many foreign observers dismissed as implausible. But in early 2021, the national statistics agency reported that there were more than 160,000 COVID-19 deaths in 2020—almost three times higher than the task force’s total—putting the country’s toll among the highest in the world. The virus continues to kill hundreds of people each day, and officials are still playing down the threat.

United States. In the country with the world’s highest total infections and fatalities, the most commonly cited databases are maintained by the Centers for Disease Control and Prevention (CDC), to which states and other jurisdictions report their tallies, and by Johns Hopkins University. Yet, in a new study by the University of Washington, scientists estimate that more than nine hundred thousand people in the United States have died of COVID-19, over 50 percent higher than the CDC and Johns Hopkins estimates.

Why are COVID-19 death figures disputed in so many places?

Guidelines for attributing deaths to the new coronavirus not only differ across countries, but even across states and cities. And oftentimes, individual doctors, medical examiners, and coroners have to make judgment calls about whether COVID-19 should be listed as the immediate cause on a death certificate; this can be particularly tricky given the virus’s ability to spur myriad health issues. The World Health Organization advises [PDF] that the deaths of victims with probable or confirmed cases be listed as due to COVID-19 “unless there is a clear alternative cause of death that cannot be related” to the disease.

Russia’s task force has repeatedly been criticized for only including cases where COVID-19 was determined to be the main cause of death in its counting method. In India, there have been discrepancies between how state health agencies and crematoriums classify the deceased during the pandemic, and experts say that in the majority of cases, causes of death are never certified. And in the United States, the CDC asks jurisdictions to report deaths from probable COVID-19 cases as well as confirmed ones, but not all do.

The challenges of counting have at times driven misinformation and controversy. President Donald Trump had suggested that hospitals were inflating the number of COVID-19 deaths to get funding boosts, though there was no evidence of this. New York Governor Andrew Cuomo has come under fire for allegedly obscuring the actual COVID-19 death toll among nursing home residents, while Florida Governor Ron DeSantis has been accused of pressuring the state’s medical examiners not to release complete data.

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