A South African report into excess deaths over the past year suggests more than 133,000 people in the country have died from COVID-19, far more than the official tally of nearly 55,000.
The South African Medical Research Council (SAMRC) has been monitoring excess deaths since May 2020.
In its latest report, published on Wednesday, the SAMRC said South Africa had seen 157,000 excess deaths in the past 12 months and estimated that 85% of them were caused by COVID-19, which means just over 133,000 people have died from the disease.
This compares to an official death toll of 54,968 since the start of the pandemic.
South Africa implemented one of the world's most restrictive lockdowns from March 2020, when cases were still relatively low, and the SAMRC said increases in weekly deaths due to the pandemic only became evident from May 2020 onwards.
Excess death figures, which some epidemiologists say are the best way to measure the true toll from COVID-19 given that counting methods vary between countries, surpass official COVID-19 death figures in many countries.
Excess deaths are typically defined as the difference between the observed numbers of deaths in specific time periods and expected numbers of deaths in the same time periods.
The SAMRC report said the excess death rate per 100,000 population for South Africa was 258 over the past 12 months. This places the country - on an age-standardised basis - in the top five countries for which excess deaths are measured.
The health ministry declined to comment immediately on the report.
Last year, South Africa imposed tough lockdown measures to curb the spread of the virus, including border closures and even bans on the sale of alcohol and cigarettes.
Most restrictions have now been lifted but a recent rise in infections has prompted fears of a third wave of the pandemic as the southern hemisphere's winter approaches.
South Africa's vaccination campaign got off to a slow start but it has now ordered millions more doses. The health ministry said on Wednesday around 430,730 shots had been administered so far, with priority given to frontline healthcare workers.
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