Table 3.

Comparison of USA, Germany, and India

	USA	Germany	India
Excess death estimates
WHO estimate (absolute count)	932,458	122,432	4,735,940
Per million population	0.28%	0.15%	0.34%
Per million non-institutionalized population (excluding COVID-19 deaths in LTCFs)*	0.18%	0.12%	0.34%
Excluding also drug overdose**	0.15%	0.12%	0.34%
Population structure and risk factors ***
Population >65 years	17%	22%	7%
Population >80 years among males	3%	6%	1%
Population >80 years among females	5%	9%	1%
Obesity in adults	42.7%	19%	5.5%
Immunocompromised among 18-64 year old	6.2%	Similar percentage to USA	Much lower percentage

^*The proportion of deaths in residents of long-term facilities among reported COVID-19 deaths in 2020-2021 is estimated at 34% for the USA and 22% for Germany (32), while it is likely to be negligible in India where long-term care facilities are very rare.

^**With an evolving an escalating drug overdose epidemic in the USA, the number of overdose deaths was preliminarily estimated at 201,277 in 2020-2021 (46) approximately 80,000 more than the average of 2015-2019 (ranging from 52,804 in 2015 to 70,630 in 2019) and this may be an underestimate. The impact of drug overdose excess in the pandemic years is considered here as negligible for Germany and India.

^***Percentage population in age and sex groups are derived from World Bank, percentage of obesity per country is from the Global Obesity Observatory (https://data.worldobesity.org/tables/prevalence-of-adult-overweight-obesity-2/) and number of immunocompromised in the USA is estimated at 15 million and 6.2% among people 18-64 years old (discussion in https://coronavirus.jhu.edu/vaccines/blog/immunocompromised-people-are-vulnerable-to-covid-19-we-owe-them-some-answers).