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Untreated other medical issues due to health system overload? Maybe combined with civil unrest and partial societal collapse?

That's about the only way the #s make sense and even than it's about an order of magnitude larger than seems plausible. It's really a number that needs explaining.

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Seems unlikely still. E.g. the american civil war cost 2% of the population. What prop dies if all medical facilities shut down entirely? Probably no more than 5%?

20% is just utterly enormous.

20% is definitely a lot. But if you look at the estimates of the death rate in Cambodia after the Khmer Rouge, they range from a bit over one million to almost three and a half in a population of roughly eight. So it does seem doable.

According to Wikipedia they killed only(!!!!!!!) like 1.5 to 2 million people (around 25%). https://en.wikipedia.org/wiki/Khmer_Rouge#Number_of_deaths

Also, Khmer Rouge had like 4 years to kill the people, and big waves of covid-19 last approximately one or two months. For example famine and unrelated illness that can't be treated because the hospitals are not working usually take more time to kill people.

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