The World Health Organization believes the COVID-19 pandemic led to almost 15 million excess deaths worldwide, The Washington Post reports, per new WHO estimates.

The tally includes both people who died of COVID-19 and those who died from COVID-19-related causes — like healthcare shortages at overwhelmed hospitals or behavioral conditions like depression that worsened in the pandemic — from Jan. 1, 2020 to Dec. 31, 2021, the Post notes.

The WHO defines excess deaths as “the difference between the number of deaths that have occurred and the number that would be expected in the absence of the pandemic based on data from earlier years.” The near-15 million estimate is almost three times the WHO’s official death count during the same time frame, per France24.

“These sobering data not only point to the impact of the pandemic but also to the need for all countries to invest in more resilient health systems that can sustain essential health services during crises, including stronger health information systems,” WHO Director General Tedros Adhanom Ghebreyesus said in a statement.

Among other high-income countries, the United States “experienced disproportionately high excess death rates because of the way we handled the pandemic,” Steven H. Woolf, senior adviser to the Center on Society and Health at Virginia Commonwealth University School of Medicine, told the Post. Woolf did not participate in the WHO’s study.

Meanwhile, the U.S. is nearing — or, by some estimates, has hit — a once-unthinkable threshold: One million direct COVID deaths.