The true global death toll from Covid-19 may be three times higher than official figures show, the World Health Organisation has said.
Estimates of excess mortality suggest the official tally of 3.4 million deaths is a significant undercount.
Excess mortality takes into account unreported virus deaths and other deaths linked indirectly to the pandemic, such as those caused by the strain on hospitals or the effects of lockdown.
Presenting its annual World Health Statistics report, the UN agency said total deaths from the pandemic in 2020 were at least three million, or 1.2 million more than officially reported.
It said the current tally was likely to be at least two or three times higher than the figure of 3.4 million.
"The challenge is that the reported Covid-19 death toll figure is an undercount of that full impact," WHO data analyst William Msemburi said.
"Excess mortality gives us a better picture, because it captures both of these direct and indirect effects."
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Visitors ride on a rollercoaster at Europa Park in Rust, western Germany, on the re-opening day of the park following the lifting of coronavirus restrictions. AFP -
An employee welcomes visitors as they enter Europa Park in Rust. Europa Park is one of the first major theme parks in Germany to reopen its doors to visitors. AFP -
A nurse shaves a patient suffering from Covid-19 at the Intensive Care Unit of the "Klinikum Darmstadt" clinic in Darmstadt, Germany. Reuters -
A cinema employee does a last-minute clean before people arrived to watch a film at the Freiluftkino Kreuzberg open-air cinema for the first time this year in Berlin, Germany. Getty Images -
Swimmers exercise in an open air pool in Berlin, Germany. Authorities are easing lockdown measures across Germany. Getty Images -
Pedestrians walk down the Kohlmarkt shopping street in Vienna, Austria. Western Europe is beginning to loosen restrictions to contain the coronavirus. Bloomberg -
A restaurant worker waits for customers alongside an outdoor dining area in the Naschmarkt in Vienna, Austria. Bloomberg -
Workers wait to collect a coronavirus disease swab sample in the Fira of Barcelona, Spain. Reuters -
People sit outdoors at a restaurant terrace near Notre Dame cathedral in Paris, France. Cafe and restaurant terraces reopened this week after a pandemic shutdown of more than six months. AP Photo
Many people suffering from chronic diseases or acute illnesses have been unable to get treatment and access healthcare due to the severity of the pandemic.
The WHO said there were indications of growing suicide rates in some parts of the world after lockdowns and other measures led to worsening levels of depression.
Even in regions with relatively reliable reporting systems, undercounts were likely.
The WHO estimated 1.1 to 1.2 million excess deaths in Europe during 2020, double the 600,000 officially tallied.
Mr Msemburi said it was unclear how many of the excess deaths could be linked to the effects of Covid-19 and that the WHO was working to determine the best methods for identifying missed Covid deaths.
Samira Asma, the WHO assistant director general in charge of data, said a safe estimate was six to eight million excess pandemic-related deaths to date.
The WHO is working with countries "to understand the true human toll of the pandemic so we can be better prepared for the next emergency", she said.
Ms Asma called on countries to invest in scaling up their data and information systems. "We can only be better prepared with better data," she said.
