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Death toll surpasses 6 million for pandemic now in 3rd year

FILE - Nurses perform timed breathing exercises on a COVID-19 patient on a ventilator in the COVID-19 intensive care unit at the la Timone hospital in...
FILE - Dr. Oleksandr Molchanov, second right, and another medical worker perform CPR on a patient at a hospital in Kakhovka, Ukraine, on Friday, Oct. ...
FILE - Registered nurse Rachel Chamberlin steps out of an isolation room where Fred Rutherford recovers from COVID-19 at the Dartmouth-Hitchcock Medic...
FILE - Nurse Marie-Laure Satta pauses during her New Year's Eve shift in the COVID-19 intensive care unit at the la Timone hospital in Marseille, sout...
FILE - Workers in protective gear bury a coronavirus victim during a funeral at a cemetery in Yogyakarta, Indonesia, Thursday, Feb. 17, 2022. The offi...
FILE - A man runs out of the heat emitting from the multiple funeral pyres of COVID-19 victims at a crematorium in the outskirts of New Delhi, India, ...
FILE - A worker handles a coronavirus test sample at a private testing site in Beijing, Wednesday, Jan. 26, 2022. The official global death toll from ...
FILE - A Red Cross worker sprays disinfectant inside an empty classroom after a case of COVID-19 was found at the school in Jakarta, Indonesia, Friday...
FILE - A health worker takes a swab sample of a man to test for the coronavirus as others wait to get tested in Ahmedabad, India, Monday, Jan. 17, 202...
FILE - Medical workers in booths take nasal samples from people at a makeshift coronavirus testing site in Seoul, South Korea, Wednesday, Jan. 26, 202...
FILE - In this photo taken by drone, cars wait in long lines at a drive-up coronavirus testing center at the Tropical Park, Wednesday, Dec. 29, 2021, ...
FILE - Patients lie on hospital beds waiting at a temporary holding area outside the Caritas Medical Centre in Hong Kong Wednesday, Feb. 16, 2022. The...
FILE - People protest Gov. Gary Herbert during an anti-mask rally outside of the Governors Mansion Saturday, Sept. 12, 2020, in Salt Lake City. The of...
FILE - Anti-lockdown protesters hold torches and banners in Vienna, Austria, Saturday, Nov. 20, 2021. The official global death toll from COVID-19 is ...
FILE - People protest mask mandates outside the State Capitol, Wednesday, Feb. 9, 2022, in Hartford, Conn. The official global death toll from COVID-1...
FILE - Kindergarten teacher Karen Drolet works with a masked student at Raices Dual Language Academy, a public school in Central Falls, R.I., Wednesda...
FILE - Police use tear gas to disperse anti-vaccine protesters during a rally at Syntagma square in central Athens, on Wednesday, July 21, 2021. The o...
FILE - Police confront protestors during a demonstration against COVID-19 measures in Brussels, Sunday, Jan. 23, 2022. The official global death toll ...
FILE - Truck drivers and others protest COVID-19 pandemic restrictions in Ottawa, Ontario, on Saturday, Feb. 12, 2022. The official global death toll ...
FILE - Passengers rush to check-in their luggage at the Miami International Airport Tuesday, Jan. 4, 2022, in Miami. The official global death toll fr...
FILE - Crowds of masked people visit the Christmas market on its final day in Frankfurt, Germany, Wednesday, Dec. 22, 2021. The official global death ...
FILE - Cincinnati Bengals fans attend a watch party for NFL football's Super Bowl 56 against the Los Angeles Rams, Sunday, Feb. 13, 2022, at Mount Loo...
FILE - A Ukrainian family fleeing the Russian invasion arrives at the border crossing in Medyka, Poland, Wednesday, March 2, 2022, after fleeing from ...
FILE - Hundreds of beds are placed inside a sports hall to accommodate Ukrainian refugees fleeing the Russian invasion at the border crossing town of ...
FILE - A patient infected with the coronavirus sits on a bed in the intensive care unit of the Afghan Japan Communicable Disease Hospital, in Kabul, A...
A security personnel wearing a face shield and a mask to help protect from the coronavirus stands watch at the Alpine downhill venue displaying the Ch...

FILE - Nurses perform timed breathing exercises on a COVID-19 patient on a ventilator in the COVID-19 intensive care unit at the la Timone hospital in...

FILE - Dr. Oleksandr Molchanov, second right, and another medical worker perform CPR on a patient at a hospital in Kakhovka, Ukraine, on Friday, Oct. ...

FILE - Registered nurse Rachel Chamberlin steps out of an isolation room where Fred Rutherford recovers from COVID-19 at the Dartmouth-Hitchcock Medic...

FILE - Nurse Marie-Laure Satta pauses during her New Year's Eve shift in the COVID-19 intensive care unit at the la Timone hospital in Marseille, sout...

FILE - Workers in protective gear bury a coronavirus victim during a funeral at a cemetery in Yogyakarta, Indonesia, Thursday, Feb. 17, 2022. The offi...

FILE - A man runs out of the heat emitting from the multiple funeral pyres of COVID-19 victims at a crematorium in the outskirts of New Delhi, India, ...

FILE - A worker handles a coronavirus test sample at a private testing site in Beijing, Wednesday, Jan. 26, 2022. The official global death toll from ...

FILE - A Red Cross worker sprays disinfectant inside an empty classroom after a case of COVID-19 was found at the school in Jakarta, Indonesia, Friday...

FILE - A health worker takes a swab sample of a man to test for the coronavirus as others wait to get tested in Ahmedabad, India, Monday, Jan. 17, 202...

FILE - Medical workers in booths take nasal samples from people at a makeshift coronavirus testing site in Seoul, South Korea, Wednesday, Jan. 26, 202...

FILE - In this photo taken by drone, cars wait in long lines at a drive-up coronavirus testing center at the Tropical Park, Wednesday, Dec. 29, 2021, ...

FILE - Patients lie on hospital beds waiting at a temporary holding area outside the Caritas Medical Centre in Hong Kong Wednesday, Feb. 16, 2022. The...

FILE - People protest Gov. Gary Herbert during an anti-mask rally outside of the Governors Mansion Saturday, Sept. 12, 2020, in Salt Lake City. The of...

FILE - Anti-lockdown protesters hold torches and banners in Vienna, Austria, Saturday, Nov. 20, 2021. The official global death toll from COVID-19 is ...

FILE - People protest mask mandates outside the State Capitol, Wednesday, Feb. 9, 2022, in Hartford, Conn. The official global death toll from COVID-1...

FILE - Kindergarten teacher Karen Drolet works with a masked student at Raices Dual Language Academy, a public school in Central Falls, R.I., Wednesda...

FILE - Police use tear gas to disperse anti-vaccine protesters during a rally at Syntagma square in central Athens, on Wednesday, July 21, 2021. The o...

FILE - Police confront protestors during a demonstration against COVID-19 measures in Brussels, Sunday, Jan. 23, 2022. The official global death toll ...

FILE - Truck drivers and others protest COVID-19 pandemic restrictions in Ottawa, Ontario, on Saturday, Feb. 12, 2022. The official global death toll ...

FILE - Passengers rush to check-in their luggage at the Miami International Airport Tuesday, Jan. 4, 2022, in Miami. The official global death toll fr...

FILE - Crowds of masked people visit the Christmas market on its final day in Frankfurt, Germany, Wednesday, Dec. 22, 2021. The official global death ...

FILE - Cincinnati Bengals fans attend a watch party for NFL football's Super Bowl 56 against the Los Angeles Rams, Sunday, Feb. 13, 2022, at Mount Loo...

FILE - A Ukrainian family fleeing the Russian invasion arrives at the border crossing in Medyka, Poland, Wednesday, March 2, 2022, after fleeing from ...

FILE - Hundreds of beds are placed inside a sports hall to accommodate Ukrainian refugees fleeing the Russian invasion at the border crossing town of ...

FILE - A patient infected with the coronavirus sits on a bed in the intensive care unit of the Afghan Japan Communicable Disease Hospital, in Kabul, A...

A security personnel wearing a face shield and a mask to help protect from the coronavirus stands watch at the Alpine downhill venue displaying the Ch...

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

The milestone, recorded by Johns Hopkins University, 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.

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 1.5 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 14.1 million and 23.8 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 18-year-old brother-in-law, Carlos Nunez Jr., in September. He was 17 when he got sick in 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.”

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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.

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Follow David Rising on Twitter @davidrising

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Follow AP’s pandemic coverage at https://apnews.com/hub/coronavirus-pandemic