Since the beginning of the COVID-19 pandemic, health authorities worldwide periodically report COVID-19 cases and deaths. These ‘official’counts are aggregated primarily from data compiled by laboratories and hospitals, 1 and they document, imperfectly, the effects of COVID-19 on population health. 2–4 Case counts are partial due to limited testing 5 and death counts might miss COVID deaths that occur outside of health facilities. 6 These figures also exclude non-COVID deaths which are indirectly a result of the pandemic (eg because of disrupted health services). 7 The total effects of the pandemic are more reliably captured by the concept of ‘excess mortality’. This is the difference between the number of deaths (from any cause) that occur during the pandemic and the number of deaths that would have occurred in the absence of the pandemic. Many analysts consider excess mortality as ‘the most objective possible indicator of the COVID-19 death toll’. 8 Four recent papers in the International Journal of Epidemiology used this counterfactual approach to paint a nuanced picture of the impact of COVID-19. 9–12 In 2020, countries like Japan 12 and Denmark 10 experienced lower than expected mortality, whereas deaths have increased substantially in the USA, UK and other countries. 9–11 Excess mortality has affected older adults disproportionately, but increases in mortality among people of working age were observed in the USA and elsewhere. 9 Gender differences in excess mortality have varied across countries. Excess deaths were also concentrated in socioeconomically disadvantaged groups. 11