Where’s REALLY had the most Covid-19 deaths? Study says Belgium but data reveals SAN MARINO

A US study of 19 countries found Belgium has had the highest death toll per 100,000 people. It was followed by Spain, the UK and US

Belgium has suffered the most coronavirus deaths for the size of its population – while the UK and US are third and fourth, according to a study.

Researchers analysed data from 19 countries with more than five million citizens and compared how many Covid-19 victims there has been for every 100,000 people living there up until September 19.

It revealed Belgium had the worst mortality rate (86.8), followed by Spain (65), the UK (62.6) and the US (60.3). For comparison, South Korea’s stood at just 0.7 – 85 times smaller than that of Britain or America. 

But when statistics for every country in the world is taken into account, Belgium falls to being the third worst-hit nation. The tiny European state of San Marino claims the grim accolade, followed by Peru and then Belgium. 

San Marino, a mountainous state surrounded by Italy, has only seen 42 Covid-19 deaths since February. But this equates to a rate of 123 per 100,000 residents when its tiny population of 33,800 is taken into account. Peru – which is home to 32million people – actually has a rate of 101 deaths per 100,000. 

Our World in Data, a website that publishes figures on large global problems using official sources, reveals the UK is 11th and the US 12th, with Andorra, Ecuador, and Mexico higher. 

India, on the other hand, has had the third highest cumulative deaths in the world, with 112,161. But due to its huge population, it places 87th in deaths per population. 

The US study, published in a medical journal, was designed to work out how many excess deaths there had been in America compared with 18 other countries.

All countries analysed were chosen because they had more than five million citizens and a GDP of at least $25,000 per capita, the researchers explain in their paper published in JAMA.

It showed the pandemic has directly or indirectly led to 225,000 deaths in the US, whether those people died of Covid-19 itself or an issue linked to the pandemic, such as delayed medical care over fears of going to hospitals amid outbreaks of the disease.

Looking at all the countries in the world, Belgium is actually not the worst-hit nation. San Marino is followed by Peru and then Belgium

Researchers at University of Pennsylvania showed 150,000 people died of Covid-19 between March and August 1. But an additional 75,000 deaths had occurred beyond what would be expected for that time period. 

The team said as of September 19, the US reported a total of 198,589 Covid-19 deaths – 60.3 deaths per 100 000.

Had it had a death toll comparable to Australia (3.3 deaths per 100 000), the US could have avoided 94 per cent of its deaths (187,661 fewer), the researchers revealed, as they blamed ‘weak public health infrastructure and a decentralised, inconsistent US response to the pandemic’.

But the US did not have the highest death toll from March to September, according to the small analysis. It was fourth, following Belgium (86.8), Spain (65) and the UK (62.6).

At the bottom of the table, South Korea and Japan have had less than one death (0.7) per 100,000 people, despite being two of the first countries to report coronavirus cases.

But the study does not paint a full picture because it’s only a small analysis of 19 countries.

PICTURED: Of the countries with the largest cumulative death tolls, these are their death rates per million people  

Our World in Data shows South America has had the highest deaths per million people to date (640), followed by North America (550) and Europe (313). Asia has had just 47 deaths per million people in comparison


The data shows the countries with the highest death toll per 100,000 people, and their cumulative death toll in brackets.

San Marino: 123.7 (42)

Peru: 101.8 (33,577)

Belgium: 88.7 (10,327)

Andorra: 76.3 (59)

Bolivia: 72 (8,407)

Spain: 71.7 (33,553)

Brazil: 71.7 (152,513)

Chile: 70.2 (13,434)

Ecuador: 69.7 (12,306)

Mexico: 66.1 (85,285)

United States: 65.7 (220,889)

United Kingdom: 63.7 (43,293)

Italy: 60.1 (36,372)

Panama: 58.6 (2,529)

Sweden: 58.5 (5,918)

Argentina: 56 (25,342)

Colombia: 55.9 (28,457)

Sint Maarten (Dutch part): 51.3 (22)

France: 50.7 (33,125)

Macedonia: 39.1 (815)

Source: Our World in Data 

Our World in Data shows that of all the 198 countries in the world, San Marino has had the highest death toll per 100,000 people by far (123.7).

It has only reported 742 confirmed Covid-19 cases since its first on February 27. But due to its small population, it means the coronavirus is highly prevalent, relative to the rest of the world. 

It has had more than 22,000 cases per million people in total – the equivalent of two people in every 100 (two per cent). It’s twice the official rate of the UK – which has recorded 9,600 cases per million people, the equivalent of 0.9 people in every 100. 

But experts insist at least 10 per cent of Britain has actually been infected since the virus first landed on UK soil in January. Millions of infected patients were never spotted because of the Government’s lacklustre testing regime.

San Marino’s estimate of prevalence is also likely to be an underestimate because a huge proportion of infected people are thought to never show any symptoms, meaning they never get swabbed. 

San Marino was declared ‘Covid-free’ on 26 June although has had several small outbreaks since, and is now recording cases every day once more, albeit it in low numbers. 

The seven-day average has hovered between one and four cases in the past week, according to Our World in Data. But no new fatalities have been recorded since June.

However, San Marino has just been added to the UK’s quarantine travel list, meaning anyone that travels there has to self isolate for 14 days on their return to the UK.

Transport Secretary Grant Shapps also announced that Italy and Vatican City State have lost their exemptions from the UK’s quarantine requirements as of Sunday at 4am.

It came after Italy recorded its biggest single-day jump in infections since the start of the outbreak, adding another 8,804 cases on Thursday. 

Looking at cumulative deaths per million people, San Marino is followed by Peru (101.8), with a number of other South American countries – Bolivia (72), Brazil (71.7), Chile (70.2) and Ecuador (69.7) – in the top 10 worst-hit nations.

Belgium (88.7), Andorra (76.3), Spain (71.7), the UK (63.7) and Italy (60.1) have had the highest death tolls per capita in Europe, after San Marino. 

They come above countries that on the surface look like they have had the highest death toll when looking only at cumulative figures.

San Marino was declared ‘Covid-free’ on 26 June although has had several outbreaks since, and is now recording cases every day once more, albeit it in low numbers


Imposing tighter controls to curb COVID-19 contagion could save hundreds of thousands of lives across Europe before February as the continent battles an exponential surge in infections, the World Health Organization (WHO) said on Thursday. 

The WHO’s European director Dr Hans Kluge cited projections from what he described as ‘reliable epidemiological models’ and said they were ‘not optimistic’ for the European region.

‘These models indicate that prolonged relaxing policies could propel – by January 2021 – daily mortality at levels 4 to 5 times higher than what we recorded in April,’ he said.

But taking simple, swift tightening measures now – such as enforcing widespread mask-wearing and controlling social gatherings in public or private spaces – could save up to 281,000 lives by February across the 53 countries that make up the WHO European region, he said.

Urging governments to ‘step up’ swiftly to contain in a second wave of the coronavirus pandemic, Dr Kluge said the current situation was, ‘more than ever, pandemic times for Europe’.

New infections are hitting 100,000 daily in Europe, and the region has just registered the highest weekly incidence of Covid-19 cases since the beginning of the pandemic, with almost 700,000 cases reported.

‘The fall (autumn) and winter surge continues to unfold in Europe, with exponential increases in daily cases and matching percentage increases in daily deaths,’ Kluge told an online media briefing.

‘It’s time To step up. The message to governments is: don’t hold back with relatively small actions to avoid the painful damaging actions we saw in the first round (in March and April).’  

‘Under proportionately more stringent scenarios, the models are reliably much more optimistic, he said, adding: ‘Pandemic times do not necessarily mean “dark times”.’

India, for example, has suffered exponentially as a result of Covid-19, with 112,161 deaths. But home to 1.3billion people, it means it comes 87th in the league table of deaths per population.

Similarly Iran is 28th, despite having the 9th highest cumulative death toll (29,605).

China, where the coronavirus first emerged in December 2019, has a staggeringly low figure of three deaths per million people, putting it at 183rd place.

Singapore (0.4), South Korea (0.8) and Japan (1.3) also appear to have escaped lightly relative to the rest of the world. Thailand (0.85) and Vietnam (0.36) are within the ten countries with the lowest death per capita despite being among the first to report coronavirus cases in January this year.

It is not clear why deaths rates per capita are slightly different for the countries included in both the list given by Our World in Data, and by the US researchers. For example Spain’s is 71 per 100,000 in the former and 65 in the latter. But it’s likely because they use different data sources and collected their figures roughly one month apart.

The findings lay bare how the crisis has led to more destruction in Western countries than in Asia.

Our World in Data shows South America has had the highest deaths per million people to date (640), followed by North America (550) and Europe (313). Asia has had just 47 deaths per million people in comparison.

Experts often put down to the fact Asia is more familiar with epidemic control, and was therefore prepared to fight against a highly contagious virus.

The south-east region has been stung with a history of emerging infectious diseases going back more than two decades, the most recent being SARS – a coronavirus similar to that which has caused the current pandemic – in 2004.

Dealing with outbreaks allowed the governments there to establish robust contact tracing systems and an action plan for when things escalate.

Behaviours such as wearing face masks were also widespread before the virus hit, making it easier to control the outbreak.

European countries, on the other hand, have not had to use contact tracing systems on a nation scale and face-mask wearing is an alien concept.

For example, it took months for the UK to set one up with potential to control the outbreak. Even now it is failing to track down a third of close contacts of Covid-19 positive cases.

And wearing a face mask in public places was not made compulsory until at least June, despite the worst of the coronavirus crisis being over.

There have now been more than one million deaths in the world from Covid-19 and 38million cases. While some countries are seeing a lull in deaths, they are accelerating in others.

EUROPE CASES AND DEATHS: Infections have been on a different path to fatalities for some time, with cases surging thanks to mass testing while hospital cases and deaths grow more slowly in much of Europe 

EUROPE 7-DAY AVERAGE DAILY NEW CASES PER MILLION PEOPLE: The Czech Republic, in purple, has the highest infection rate in Europe – ahead of hard-hit Western European countries such as the Netherlands (in red), France (in blue) and Spain (in orange)