The US is approaching one million Covid deaths – the highest total officially recorded anywhere in the world.

But a new report from the World Health Organization (WHO) shows several other countries recorded more deaths above their normal levels than the US over the last two years.

So does the US really have the highest Covid death toll, and by what measure?

US deaths above global average

There’s no international standard for measuring deaths or their causes, and countries record deaths in different ways, which makes comparison difficult.

But experts say one of the most accurate measures is how many extra deaths are recorded in a country above the number that would have been expected to die in an average year.

Many countries publish excess death data, but some poorer nations don’t or do it far less frequently.

The WHO has published a report calculating every country’s excess death count for 2020 and 2021.

This measure takes into account deaths not directly due to Covid, but as a consequence of the pandemic, such as people being unable to access hospitals for the care they needed.

It also accounts for poor record-keeping in some regions.

The report concludes that, although the US was not the worst hit country in the world by this measure, it remained in the top five in terms of overall numbers of deaths.

According to the WHO, in 2020 and 2021 the US recorded more than 930,000 excess deaths, behind India (4.7m), Russia (1.1m) and Indonesia (1m).

The WHO’s numbers are largely consistent with statistics from the Economist which run into 2022, as well as other excess death studies.

When adjusted for population size, the US slips down the rankings with 140 excess deaths per 100,000 people. But it remains a long way above the global average of 96 per 100,000 – and it’s also one of the worst performing among the most developed nations.

Prabhat Jha, an epidemiologist who worked on the WHO report, says: “The US has about a 15% undercount using excess deaths compared to official Covid deaths – that’s mostly a result of some of the early problems that occurred with nursing home deaths being missed.”

“On the whole the US isn’t missing many deaths compared with, say, India,” he adds.

But the US has a larger population than many other countries.

When you look at the same top 10 countries in per capita terms, the US is below both Brazil and Peru for recorded Covid deaths.

“Short term I think the per capita confirmed death rate is a pretty good indicator” says Justin Lessler, professor of epidemiology at the University of North Carolina.

“The US is not the highest, but it’s certainly on the higher end.”

Experts say it’s also important to take the average age of a country’s population into account.

“We should compare with countries which have similar age structures as we know Covid has a higher fatality rate in the elderly – so we should compare apples to apples,” says Bhramar Mukherjee, professor of epidemiology at the University of Michigan.

When comparing with Spain, UK, and France, as well as neighbouring Canada – developed countries with similarly aged populations to the US – the US has performed worse.

“A lot of the European countries – like the UK, France and Spain – are reasonable to compare, and they’ve had lower per capita death rates. It’s not night and day, but the US is on the upper end of that spectrum,” says Professor Lessler.