An interesting preprint in medRxiv published January 2021 looked at this question. 

Factors such as non-uniform definitions of mortality, uncertainty in diseases prevalence, and bias sampling complicates the quantification of fatality during an epidemic. 

Regardless of the employed fatality measure, the injected population and the number of injection caused deaths needs to be consistently estimated for the comparing mortality across regions.

The authors combined historical and current mortality data, a statistical testing model, and an SIR epidemic model, to improve the estimation of mortality. 

They found that the average excess deaths across the entire United States was 13% higher than the number of reported COVID-19 deaths. 

In some areas such as New York City, the number of weekly deaths was able eight times higher than in previous years. 

Other countries such as Peru, Ecuador, Mexico and Spain also exhibited excess deaths significantly higher than their reported COVID-19 deaths. 

Conversely, they found negligible or negative excess deaths in part and all of 2020 for Denmark, Germany and Norway. 

This study highlighted the difficulty in comparing different regions by death rate for COVID mortality. 

Dr Paul Ettlinger 

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