Death numbers have been reported since the beginning of the COVID-19 pandemic, but they may not represent the true impact of the pandemic. Excess mortality is a robust metric and a critical indicator of the impact of the COVID-19 pandemic. P-scores provide estimates of excess mortality and have been widely utilized in many COVID-19 studies around the world. P-score analyses have revealed more pandemic-associated deaths than official COVID-19 statistics alone. While a substantial proportion of excess mortality during the COVID-19 pandemic can be directly attributed to the virus infection itself, mortality from major non-infectious chronic diseases substantially contributed to an increase in excess mortality P-scores. Thoughtful considerations of approaches to defining counterfactual mortality are important for ensuring the validity of calculated P-scores.
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