BANGKOK (AP) — The of­fi­cial glob­al death toll from COVID-19 is on the verge of eclips­ing 6 mil­lion — un­der­scor­ing that the pan­dem­ic, now in its third year, is far from over.

The mile­stone is the lat­est trag­ic re­minder of the un­re­lent­ing na­ture of the pan­dem­ic even as peo­ple are shed­ding masks, trav­el is re­sum­ing and busi­ness­es are re­open­ing around the globe. The death toll, com­piled by Johns Hop­kins Uni­ver­si­ty, stood at 5,996,882 as of Sun­day morn­ing and was ex­pect­ed to pass the 6 mil­lion mark lat­er in the day.

Re­mote Pa­cif­ic is­lands, whose iso­la­tion had pro­tect­ed them for more than two years, are just now grap­pling with their first out­breaks and deaths, fu­eled by the high­ly con­ta­gious omi­cron vari­ant.

Hong Kong, which is see­ing deaths soar, is test­ing its en­tire pop­u­la­tion of 7.5 mil­lion three times this month as it clings to main­land Chi­na’s “ze­ro-COVID” strat­e­gy.

As death rates re­main high in Poland, Hun­gary, Ro­ma­nia and oth­er East­ern Eu­ro­pean coun­tries, the re­gion has seen more than 1 mil­lion refugees ar­rive from war-torn Ukraine, a coun­try with poor vac­ci­na­tion cov­er­age and high rates of cas­es and deaths.

And de­spite its wealth and vac­cine avail­abil­i­ty, the Unit­ed States is near­ing 1 mil­lion re­port­ed deaths on its own.

Death rates world­wide are still high­est among peo­ple un­vac­ci­nat­ed against the virus, said Tik­ki Pang, a vis­it­ing pro­fes­sor at the Na­tion­al Uni­ver­si­ty of Sin­ga­pore’s med­ical school and co-Chair of the Asia Pa­cif­ic Im­mu­niza­tion Coali­tion.

“This is a dis­ease of the un­vac­ci­nat­ed — look what is hap­pen­ing in Hong Kong right now, the health sys­tem is be­ing over­whelmed,” said Pang, the for­mer di­rec­tor of re­search pol­i­cy and co­op­er­a­tion with the World Health Or­ga­ni­za­tion. “The large ma­jor­i­ty of the deaths and the se­vere cas­es are in the un­vac­ci­nat­ed, vul­ner­a­ble seg­ment of the pop­u­la­tion.”

It took the world sev­en months to record its first mil­lion deaths from the virus af­ter the pan­dem­ic be­gan in ear­ly 2020. Four months lat­er an­oth­er mil­lion peo­ple had died, and 1 mil­lion have died every three months since, un­til the death toll hit 5 mil­lion at the end of Oc­to­ber. Now it has reached 6 mil­lion — more than the pop­u­la­tions of Berlin and Brus­sels com­bined, or the en­tire state of Mary­land.

But de­spite the enor­mi­ty of the fig­ure, the world un­doubt­ed­ly hit its 6 mil­lionth death some time ago. Poor record-keep­ing and test­ing in many parts of the world has led to an un­der­count in coro­n­avirus deaths, in ad­di­tion to ex­cess deaths re­lat­ed to the pan­dem­ic but not from ac­tu­al COVID-19 in­fec­tions, like peo­ple who died from pre­ventable caus­es but could not re­ceive treat­ment be­cause hos­pi­tals were full.

Edouard Math­ieu, head of da­ta for the Our World in Da­ta por­tal, said that — when coun­tries’ ex­cess mor­tal­i­ty fig­ures are stud­ied — as many as near­ly four times the re­port­ed death toll have like­ly died be­cause of the pan­dem­ic.

An analy­sis of ex­cess deaths by a team at The Econ­o­mist es­ti­mates that the num­ber of COVID-19 deaths is be­tween 14 mil­lion and 23.5 mil­lion.

“Con­firmed deaths rep­re­sent a frac­tion of the true num­ber of deaths due to COVID, most­ly be­cause of lim­it­ed test­ing, and chal­lenges in the at­tri­bu­tion of the cause of death,” Math­ieu told The As­so­ci­at­ed Press. “In some, most­ly rich, coun­tries that frac­tion is high and the of­fi­cial tal­ly can be con­sid­ered to be fair­ly ac­cu­rate, but in oth­ers it is high­ly un­der­es­ti­mat­ed.”

The Unit­ed States has the biggest of­fi­cial death toll in the world, but the num­bers have been trend­ing down­ward over the last month.

Lon­nie Bai­ley lost his 17-year-old nephew, Car­los Nunez Jr., who con­tract­ed COVID-19 last April — the same month Ken­tucky opened his age group to vac­ci­na­tions. The Louisville res­i­dent said the fam­i­ly is still suf­fer­ing, in­clud­ing Car­los’ younger sib­ling, who had to be hos­pi­tal­ized him­self and still has lin­ger­ing symp­toms. The ag­gres­sive re­open­ing of the coun­try has been jar­ring for them to wit­ness.

“For us it is hard to let our guard down; it’s go­ing to take a while for us to ad­just,” Bai­ley said.

The world has seen more than 445 mil­lion con­firmed COVID-19 cas­es, and new week­ly cas­es have been de­clin­ing re­cent­ly in all re­gions ex­cept for the West­ern Pa­cif­ic, which in­cludes Chi­na, Japan and South Ko­rea, among oth­ers, the World Health Or­ga­ni­za­tion re­port­ed this week.

Al­though the over­all fig­ures in the Pa­cif­ic is­lands see­ing their first out­breaks are small com­pared to larg­er coun­tries, they are sig­nif­i­cant among their tiny pop­u­la­tions and threat­en to over­whelm frag­ile health care sys­tems.

“Giv­en what we know about COVID … it’s like­ly to hit them for the next year or so at least,” said Katie Green­wood, head of the Red Cross Pa­cif­ic del­e­ga­tion.

Ton­ga re­port­ed its first out­break af­ter the virus ar­rived with in­ter­na­tion­al aid ves­sels fol­low­ing the Jan. 15 erup­tion of a mas­sive vol­cano, fol­lowed by a tsuna­mi. It now has sev­er­al hun­dred cas­es, but — with 66% of its pop­u­la­tion ful­ly vac­ci­nat­ed — it has so far re­port­ed peo­ple suf­fer­ing most­ly mild symp­toms and no deaths.

The Solomon Is­lands saw the first out­break in Jan­u­ary and now has thou­sands of cas­es and more than 100 deaths. The ac­tu­al death toll is like­ly much high­er, with the cap­i­tal’s hos­pi­tal over­whelmed and many dy­ing at home, Green­wood said.

On­ly 12% of Solomon Is­landers are ful­ly vac­ci­nat­ed, though the out­break has pro­vid­ed new im­pe­tus to the coun­try’s vac­ci­na­tion cam­paign and 29% now have at least one shot.

Glob­al vac­cine dis­par­i­ty con­tin­ues, with on­ly 6.95% of peo­ple in low-in­come coun­tries ful­ly vac­ci­nat­ed, com­pared to more than 73% in high-in­come na­tions, ac­cord­ing to Our World in Da­ta.

In a good sign, at the end of last month Africa sur­passed Eu­rope in the num­ber of dos­es ad­min­is­tered dai­ly, but on­ly about 12.5% of its pop­u­la­tion has re­ceived two shots.

The Africa Cen­ters for Dis­ease Con­trol and Pre­ven­tion is still press­ing for more vac­cines, though it has been a chal­lenge. Some ship­ments ar­rive with lit­tle warn­ing for coun­tries’ health sys­tems and oth­ers near the ex­pi­ra­tion date — forc­ing dos­es to be de­stroyed.

East­ern Eu­rope has been par­tic­u­lar­ly hard hit by the omi­cron vari­ant, and with the Russ­ian in­va­sion of Ukraine, a new risk has emerged as hun­dreds of thou­sands of peo­ple flee to places like Poland on crowd­ed trains. Health of­fi­cials there have been of­fer­ing free vac­ci­na­tions to all refugees, but have not been mak­ing them test up­on ar­rival or quar­an­tine.

“This is re­al­ly trag­ic be­cause great stress has a very neg­a­tive ef­fect on nat­ur­al im­mu­ni­ty and in­creas­es the risk of in­fec­tions,” said An­na Boron-Kacz­mars­ka, a Pol­ish in­fec­tious dis­ease spe­cial­ist. “They are in very high stress, be­ing afraid for their lives, the lives of their chil­dren, they fam­i­ly mem­bers.”

Mex­i­co has re­port­ed 300,000 deaths, but with lit­tle test­ing, a gov­ern­ment analy­sis of death cer­tifi­cates puts the re­al num­ber clos­er to 500,000. Still, four weeks of falling in­fec­tion rates have left health of­fi­cials op­ti­mistic.

In In­dia, where the world was shocked by im­ages of open-air pyres of bod­ies burned as cre­ma­to­ria were over­whelmed, the scars are fad­ing as the num­ber of new cas­es and deaths has slowed.

In­dia has record­ed more than 500,000 deaths, but ex­perts be­lieve its true toll is in the mil­lions, pri­mar­i­ly from the delta vari­ant. Mi­grants from In­dia’s vast hin­ter­land are now re­turn­ing to its megac­i­ties in search of jobs, and the streets are packed with traf­fic. Shop­ping malls have cus­tomers, al­beit still masked, while schools and uni­ver­si­ties are wel­com­ing stu­dents af­ter a months-long gap.

In Britain, in­fec­tions have fall­en since an omi­cron-dri­ven surge in De­cem­ber, but re­main high. Eng­land has now lift­ed all re­stric­tions, in­clud­ing mask man­dates and the re­quire­ment that all who test pos­i­tive iso­late at home.

With about 250,000 re­port­ed deaths, the African con­ti­nent’s small­er death toll is thought to stem from un­der­re­port­ing, as well as a gen­er­al­ly younger and less mo­bile pop­u­la­tion.

“Africa is a big ques­tion mark for me, be­cause it has been rel­a­tive­ly spared from the worst so far, but it could just be a time bomb,” Pang said, not­ing its low vac­ci­na­tion rates.

In South Africa, Sowe­to res­i­dent Thoko Dube said she re­ceived news of the deaths of two fam­i­ly mem­bers on the same day in Jan­u­ary 2021 — a month be­fore the coun­try re­ceived its first vac­cines.

It has been dif­fi­cult, but “the fam­i­ly is cop­ing,” she said. “We have ac­cept­ed it be­cause it has been hap­pen­ing to oth­er fam­i­lies.”

By David Ris­ing

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AP jour­nal­ists Jill Law­less in Lon­don, Anirud­dha Ghos­al in New Del­hi, Cara An­na in Nairo­bi, Mogo­mot­si Magome in Jo­han­nes­burg, Moni­ka Scis­lows­ka in War­saw, Fabi­o­la Sanchez in Mex­i­co City, and Heather Hollingsworth in Mis­sion, Kansas, con­tributed to this sto­ry.

Source: As­so­ci­at­ed Press