Workers clad in hazmat suits bury the coffin of a coronavirus victim

Workers carry out a burial wearing full protective equipment at Pondok Ranggon COVID-19 cemetery in Jakarta.Credit: Mast Irham/EPA-EFE/Shutterstock

Nine months into the coronavirus pandemic, the official global death toll has now exceeded one million people. But researchers warn that this figure probably vastly underestimates the actual number of people who have died from COVID-19. And, in a worst-case scenario, one group of modellers suggests that the number of deaths could exceed 3 million people by January.

The one-million milestone was hit on 28 September, according to the COVID case tracker maintained by Johns Hopkins University in Baltimore, Maryland.

In reality, it is likely that this number “was exceeded some time ago”, says Andrea Gómez Ayora, an epidemiologist at the University of Chile in Santiago. Many deaths related to the coronavirus have gone unreported, she says, particularly in countries where testing isn’t widespread. The death toll will continue to rise as diagnostic capacity increases around the globe.

Nevertheless, this is a significant moment, says Naomi Rogers, a historian of medicine at Yale University in New Haven, Connecticut. “It’s an even more powerful example of the devastation of this particular pandemic, which, as we live through it, has been very easy to normalize.”

COVID-19 deaths: Line chart showing the cumulative worldwide deaths caused by COVID-19 in 2020.

Sources: World Health Organization; Johns Hopkins University

“We could have avoided many of these deaths,” says Ali Mokdad, an epidemiologist at the University of Washington’s Institute for Health Metrics and Evaluation (IHME) in Seattle. For example, in the United States — which has the highest national death toll, at more than 200,000 — it is likely that a national mandate on wearing face masks in public would have helped to reduce the rates of coronavirus transmission, he says.

How many more deaths we will see in the next months will depend on how governments respond to the pandemic, Mokdad adds.

Dark days

Using official data on COVID-19 from different nations, the IHME projected the global impact of the pandemic under several scenarios. The researchers estimate that, if current trends continue, by next January the total number of deaths will reach 2.5 million, a figure that could be cut to 1.8 million if every country adopts universal mask-wearing. Their models suggest that if at least 95% of the population starts wearing a mask within 7 days, the average number of daily deaths expected by January could drop from the current projection of almost 33,300 to around 17,450.

But, under different conditions, the situation could worsen. If governments lift precautions such as social distancing and restrictions on gatherings, the death toll could climb further, reaching 3.3 million by January 2021, with around 72,700 people dying each day. “We are heading into a difficult time.” says Mokdad.

The pandemic will also cause deaths that are not included in the official COVID-19 tally, he adds, because of knock-on effects that are beginning to emerge. These include a decline in childhood vaccinations as people avoid clinics, rising consumption of alcohol and illegal drugs, and increased mortality from other diseases as overstretched health-care systems struggle to keep them at bay.

Other researchers are hopeful that the death count passing the one-million mark could represent a turning point in the course of the pandemic. “I hope that there’s something about the notion of a million, which is such a powerful number, [that] this could potentially be a kind of wake-up moment,” says Rogers.

With a constant stream of pandemic data, there is a risk of forgetting “what the number represents: the pain of many families who saw a loved one lose their breath”, says Camila Montesinos Guevara, a global-health specialist at the UTE University in Quito, Ecuador. “It’s not a matter of just looking at the numbers.”