The Casualties of War: An Excess Mortality Estimate of Lives Lost in the 2020 Nagorno-Karabakh Conflict.

Who and how many died in the 2020 Karabakh War? With limited evidence provided by authorities, media outlets, and human rights organizations, still little is known about the death toll caused by the 44-day conflict in and around Nagorno-Karabakh. This paper provides a first assessment of the human cost of the war. Using age-sex vital registration data from Armenia, Azerbaijan, and the de facto Republic of Artsakh/Nagorno-Karabakh, we difference the 2020 observed mortality values from expected deaths based on trends in mortality between 2015 and 2019 to offer sensible estimates of excess mortality resulting from the conflict. We compare and contrast our findings with neighboring peaceful countries with similar mortality patterns and socio-cultural background and discuss them against the backdrop of the concurrent first wave of Covid-19. We estimate that the war led to almost 6,500 excess deaths among people aged 15-49. Nearly 2,800 excess losses occurred in Armenia, 3,400 in Azerbaijan, and 310 in de facto Artsakh. Deaths were highly concentrated among late adolescent and young adult males, suggesting that most excess mortality was directly related to combat. Beyond the human tragedy, for small countries like Armenia and Azerbaijan, such loss of young men represents a considerable long-term cost for future demographic, economic, and social development. Supplementary Information: The online version contains supplementary material available at 10.1007/s11113-023-09790-2.

The WHO estimates of excess mortality associated with the COVID-19 pandemic.

The World Health Organization has a mandate to compile and disseminate statistics on mortality, and we have been tracking the progression of the COVID-19 pandemic since the beginning of 20201. Reported statistics on COVID-19 mortality are problematic for many countries owing to variations in testing access, differential diagnostic capacity and inconsistent certification of COVID-19 as cause of death. Beyond what is directly attributable to it, the pandemic has caused extensive collateral damage that has led to losses of lives and livelihoods. Here we report a comprehensive and consistent measurement of the impact of the COVID-19 pandemic by estimating excess deaths, by month, for 2020 and 2021. We predict the pandemic period all-cause deaths in locations lacking complete reported data using an overdispersed Poisson count framework that applies Bayesian inference techniques to quantify uncertainty. We estimate 14.83 million excess deaths globally, 2.74 times more deaths than the 5.42 million reported as due to COVID-19 for the period. There are wide variations in the excess death estimates across the six World Health Organization regions. We describe the data and methods used to generate these estimates and highlight the need for better reporting where gaps persist. We discuss various summary measures, and the hazards of ranking countries' epidemic responses.

A framework for reconstructing SARS-CoV-2 transmission dynamics using excess mortality data.

The transmission dynamics and burden of SARS-CoV-2 in many regions of the world is still largely unknown due to the scarcity of epidemiological analyses and lack of testing to assess the prevalence of disease. In this work, we develop a quantitative framework based on excess mortality data to reconstruct SARS-CoV-2 transmission dynamics and assess the level of underreporting in infections and deaths. Using weekly all-cause mortality data from Iran, we are able to show a strong agreement between our attack rate estimates and seroprevalence measurements in each province and find significant heterogeneity in the level of exposure across the country with 11 provinces reaching near 100% attack rates. Despite having a young population, our analysis reveals that incorporating limited access to medical services in our model, coupled with undercounting of COVID-19-related deaths, leads to estimates of infection fatality rate in most provinces of Iran that are comparable to high-income countries.

Estimating national excess mortality from subnational data: application to Argentina.

This paper presents a method to estimate excess mortality where national data are missing for some or all of the coronavirus disease 2019 (COVID-19) pandemic period, but subnational data exist, such as in Argentina. By making use of the stability of the regional distribution of deaths, data on deaths in Córdoba province were used to project excess deaths in Argentina from March 2020 up to the end of 2021. The number of excess deaths was estimated at 134 504, which is 14.8% higher than the reported number of COVID-19 deaths in Argentina for the same time period.

En este estudio se presenta un método para calcular el exceso de mortalidad cuando no se dispone de datos nacionales de una parte o la totalidad del período de la pandemia de la enfermedad por el coronavirus del 2019 (COVID-19), pero sí se cuenta con datos subnacionales, como es el caso en Argentina. Aprovechando la estabilidad de la distribución regional de las muertes, se emplearon los datos sobre las muertes en la provincia de Córdoba para hacer una proyección del exceso de mortalidad en Argentina desde marzo del 2020 hasta finales del 2021. Se estimó en 134 504 el número de muertes en exceso, que es 14,8% mayor que la cifra notificada de muertes por COVID-19 en Argentina en el mismo período.

Este artigo apresenta um método para estimar o excesso de mortalidade durante a pandemia da doença causada pelo coronavírus 2019 (COVID-19) na Argentina quando faltam dados nacionais relativos a um dado período ­ ou ao período inteiro ­, mas existem dados subnacionais disponíveis. Diante da estabilidade da distribuição regional das mortes, foram usados os dados de mortalidade da Província de Córdoba para fazer uma projeção do excesso de mortes ocorridas no país entre março de 2020 e o final de 2021. Estimou-se um excesso de 134 504 mortes, o que corresponde a 14,8% a mais do número notificado de mortes por COVID-19 na Argentina no mesmo período.

Estimating national excess mortality from subnational data: application to Argentina

[ABSTRACT]. This paper presents a method to estimate excess mortality where national data are missing for some or all of the coronavirus disease 2019 (COVID-19) pandemic period, but subnational data exist, such as in Argentina. By making use of the stability of the regional distribution of deaths, data on deaths in Córdoba province were used to project excess deaths in Argentina from March 2020 up to the end of 2021. The number of excess deaths was estimated at 134 504, which is 14.8% higher than the reported number of COVID-19 deaths in Argentina for the same time period.

[RESUMEN]. En este estudio se presenta un método para calcular el exceso de mortalidad cuando no se dispone de datos nacionales de una parte o la totalidad del período de la pandemia de la enfermedad por el coronavirus del 2019 (COVID-19), pero sí se cuenta con datos subnacionales, como es el caso en Argentina. Aprovechando la estabilidad de la distribución regional de las muertes, se emplearon los datos sobre las muertes en la provincia de Córdoba para hacer una proyección del exceso de mortalidad en Argentina desde marzo del 2020 hasta finales del 2021. Se estimó en 134 504 el número de muertes en exceso, que es 14,8% mayor que la cifra notificada de muertes por COVID-19 en Argentina en el mismo período.

[RESUMO]. Este artigo apresenta um método para estimar o excesso de mortalidade durante a pandemia da doença causada pelo coronavírus 2019 (COVID-19) na Argentina quando faltam dados nacionais relativos a um dado período – ou ao período inteiro –, mas existem dados subnacionais disponíveis. Diante da estabilidade da distribuição regional das mortes, foram usados os dados de mortalidade da Província de Córdoba para fazer uma projeção do excesso de mortes ocorridas no país entre março de 2020 e o final de 2021. Estimou-se um excesso de 134 504 mortes, o que corresponde a 14,8% a mais do número notificado de mortes por COVID- 19 na Argentina no mesmo período.

Estimating national excess mortality from subnational data: application to Argentina / Cálculo de la tasa nacional de exceso de mortalidad con datos subnacionales: el caso de Argentina / Estimativa do excesso de mortalidade nacional a partir de dados subnacionais: o caso da Argentina

ABSTRACT This paper presents a method to estimate excess mortality where national data are missing for some or all of the coronavirus disease 2019 (COVID-19) pandemic period, but subnational data exist, such as in Argentina. By making use of the stability of the regional distribution of deaths, data on deaths in Córdoba province were used to project excess deaths in Argentina from March 2020 up to the end of 2021. The number of excess deaths was estimated at 134 504, which is 14.8% higher than the reported number of COVID-19 deaths in Argentina for the same time period.

RESUMEN En este estudio se presenta un método para calcular el exceso de mortalidad cuando no se dispone de datos nacionales de una parte o la totalidad del período de la pandemia de la enfermedad por el coronavirus del 2019 (COVID-19), pero sí se cuenta con datos subnacionales, como es el caso en Argentina. Aprovechando la estabilidad de la distribución regional de las muertes, se emplearon los datos sobre las muertes en la provincia de Córdoba para hacer una proyección del exceso de mortalidad en Argentina desde marzo del 2020 hasta finales del 2021. Se estimó en 134 504 el número de muertes en exceso, que es 14,8% mayor que la cifra notificada de muertes por COVID-19 en Argentina en el mismo período.

RESUMO Este artigo apresenta um método para estimar o excesso de mortalidade durante a pandemia da doença causada pelo coronavírus 2019 (COVID-19) na Argentina quando faltam dados nacionais relativos a um dado período - ou ao período inteiro -, mas existem dados subnacionais disponíveis. Diante da estabilidade da distribuição regional das mortes, foram usados os dados de mortalidade da Província de Córdoba para fazer uma projeção do excesso de mortes ocorridas no país entre março de 2020 e o final de 2021. Estimou-se um excesso de 134 504 mortes, o que corresponde a 14,8% a mais do número notificado de mortes por COVID-19 na Argentina no mesmo período.

Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset.

Comparing the impact of the COVID-19 pandemic between countries or across time is difficult because the reported numbers of cases and deaths can be strongly affected by testing capacity and reporting policy. Excess mortality, defined as the increase in all-cause mortality relative to the expected mortality, is widely considered as a more objective indicator of the COVID-19 death toll. However, there has been no global, frequently updated repository of the all-cause mortality data across countries. To fill this gap, we have collected weekly, monthly, or quarterly all-cause mortality data from 103 countries and territories, openly available as the regularly updated World Mortality Dataset. We used this dataset to compute the excess mortality in each country during the COVID-19 pandemic. We found that in several worst-affected countries (Peru, Ecuador, Bolivia, Mexico) the excess mortality was above 50% of the expected annual mortality (Peru, Ecuador, Bolivia, Mexico) or above 400 excess deaths per 100,000 population (Peru, Bulgaria, North Macedonia, Serbia). At the same time, in several other countries (e.g. Australia and New Zealand) mortality during the pandemic was below the usual level, presumably due to social distancing measures decreasing the non-COVID infectious mortality. Furthermore, we found that while many countries have been reporting the COVID-19 deaths very accurately, some countries have been substantially underreporting their COVID-19 deaths (e.g. Nicaragua, Russia, Uzbekistan), by up to two orders of magnitude (Tajikistan). Our results highlight the importance of open and rapid all-cause mortality reporting for pandemic monitoring.

Countries around the world reported 4.2 million deaths from SARS-CoV-2 (the virus that causes COVID-19) from the beginning of pandemic until the end of July 2021, but the actual number of deaths is likely higher. While some countries may have imperfect systems for counting deaths, others may have intentionally underreported them. To get a better estimate of deaths from an event such as a pandemic, scientists often compare the total number of deaths in a country during the event to the expected number of deaths based on data from previous years. This tells them how many excess deaths occurred during the event. To provide a more accurate count of deaths caused by COVID-19, Karlinsky and Kobak built a database called the World Mortality Dataset. It includes information on deaths from all causes from 103 countries. Karlinsky and Kobak used the database to compare the number of reported COVID-19 deaths reported to the excess deaths from all causes during the pandemic. Some of the hardest hit countries, including Peru, Ecuador, Bolivia, and Mexico, experienced over 50% more deaths than expected during the pandemic. Meanwhile, other countries like Australia and New Zealand, reported fewer deaths than normal. This is likely because social distancing measures reduced deaths from infections like influenza. Many countries reported their COVID-19 deaths accurately, but Karlinsky and Kobak argue that other countries, including Nicaragua, Russia, and Uzbekistan, underreported COVID-19 deaths. Using their database, Karlinsky and Kobak estimate that, in those countries, there have been at least 1.4 times more deaths due to COVID-19 than reported ­ adding over 1 million extra deaths in total. But they note that the actual number is likely much higher because data from more than 100 countries were not available to include in the database. The World Mortality Dataset provides a more accurate picture of the number of people who died because of the COVID-19 pandemic, and it is available online and updated daily. The database may help scientists develop better mitigation strategies for this pandemic or future ones.

The World Mortality Dataset: Tracking excess mortality across countries during the COVID-19 pandemic.

Comparing the impact of the COVID-19 pandemic between countries or across time is difficult because the reported numbers of cases and deaths can be strongly affected by testing capacity and reporting policy. Excess mortality, defined as the increase in all-cause mortality relative to the expected mortality, is widely considered as a more objective indicator of the COVID-19 death toll. However, there has been no global, frequently-updated repository of the all-cause mortality data across countries. To fill this gap, we have collected weekly, monthly, or quarterly all-cause mortality data from 94 countries and territories, openly available as the regularly-updated World Mortality Dataset. We used this dataset to compute the excess mortality in each country during the COVID-19 pandemic. We found that in several worst-affected countries (Peru, Ecuador, Bolivia, Mexico) the excess mortality was above 50% of the expected annual mortality. At the same time, in several other countries (Australia, New Zealand) mortality during the pandemic was below the usual level, presumably due to social distancing measures decreasing the non-COVID infectious mortality. Furthermore, we found that while many countries have been reporting the COVID-19 deaths very accurately, some countries have been substantially underreporting their COVID-19 deaths (e.g. Nicaragua, Russia, Uzbekistan), sometimes by two orders of magnitude (Tajikistan). Our results highlight the importance of open and rapid all-cause mortality reporting for pandemic monitoring.