key: cord-0801589-het5173i authors: Khafaie, Morteza Abdullatif; Rahim, Fakher title: Cross-Country Comparison of Case Fatality Rates of COVID-19/SARS-COV-2 date: 2020-04-03 journal: Osong Public Health Res Perspect DOI: 10.24171/j.phrp.2020.11.2.03 sha: 08a6e7924103b4a001ff84d7db7dcd5560950fa1 doc_id: 801589 cord_uid: het5173i OBJECTIVES: Case fatality rates (CFR) and recovery rates are important readouts during epidemics and pandemics. In this article, an international analysis was performed on the ongoing coronavirus disease 2019 (COVID-19) pandemic. METHODS: Data were retrieved from accurate databases according to the user’s guide of data sources for patient registries, CFR and recovery rates were calculated for each country. A comparison of CFR between countries with total cases ≥ 1,000 was observed for 12(th) and 23(rd) March. RESULTS: Italy’s CFR was the highest of all countries studied for both time points (12(th) March, 6.22% versus 23(rd) March, 9.26%). The data showed that even though Italy was the only European country reported on 12(rd) March, Spain and France had the highest CFR of 6.16 and 4.21%, respectively, on 23(rd) March, which was strikingly higher than the overall CFR of 3.61%. CONCLUSION: Obtaining detailed and accurate medical history from COVID-19 patients, and analyzing CFR alongside the recovery rate, may enable the identification of the highest risk areas so that efficient medical care may be provided. This may lead to the development of point-of-care tools to help clinicians in stratifying patients based on possible requirements in the level of care, to increase the probabilities of survival from COVID-19 disease. A novel coronavirus has spread through China, originating from the city of Wuhan and has caused many deaths so far. It is a highly contagious virus that has spread rapidly and efficiently. Coronavirus disease 2019 (COVID-19) is caused by a virus (SARS-CoV-2) from the same family as the lethal coronaviruses that caused severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV). COVID-19 is a relatively large virus (120 nm) and is enveloped, containing a positive-sense single-stranded RNA [1] . The virus is transmitted through direct contact with the infected person's respiratory droplets (coughing and sneezing), as well as contact with infected surfaces. COVID-19 virus can survive for days on surfaces, but a simple disinfectant can eliminate this [2] . COVID-19 signs and symptoms include fever, cough, and shortness of breath. In more severe cases, infection can lead to pneumonia, serious respiratory problems and ultimately, fatalities. Thousands of people have been reported to have been infected with the virus so far [3] . Apart from China, other cases of the disease, also known as COVID-2, have been reported in several countries, including Thailand, South *Corresponding author: Fakher Rahim Korea, Japan, Taiwan, Australia, Iran, and the United States. According to the Worldometer, as of 10 th March 2020, there are over 114,430 identified cases of COVID-19 worldwide in 115 countries and territories [1] . Of these 115 countries, South Korea and Iran (outside of China) have the largest epidemic of COVID-19 and Italy, France and Spain are the countries with a major epidemic of COVID-19 in Europe [2] . COVID-19 spreads mainly from person-to-person during the latency period before the symptoms appear [4] . There is much more to learn about the spread and severity of COVID-19. COVID-19 can cause mild flu-like symptoms, including fever, cough, dyspnea, myalgia, and fatigue, while more serious forms can cause severe pneumonia, acute respiratory distress syndrome, septic shock, and organ failure, which can lead to death [5] . Without a vaccine for COVID-19, transmission of the virus can be reduced with early detection and patient quarantine [6] . There is epidemiological and clinical evidence to suggest a number of novel compounds, as well as medicines licensed for other conditions, that appear to have potential efficacy against COVID-19 [7, 8] . However, in the absence of a safe and effective vaccine or medicine, reducing viral transmission is the only strategy available where general education, and implementing the appropriate prevention and control is key. Precautions can help suppress the risk of infection, such as washing the hands frequently with soap and water or an alcohol-based disinfectant gel, coughing into the elbow or a folded napkin/tissue, avoiding close contact with those who have symptoms, and self-isolating, but medical help must be sought if difficulty in breathing is experienced [5] . COVID-19 can be diagnosed with diagnostic test kits [9] and imaging techniques such as chest X-ray and pulmonary CT scans that facilitate early diagnosis of pneumonia in patients with COVID-19 [10] [11] [12] . The case fatality rate (CFR), is a measure of the ability of a pathogen or virus to infect or damage a host in infectious disease and is described as the proportion of deaths within a defined population of interest, i.e. the percentage of cases that result in death [13] . CFRs confers the extent of disease severity and CFR is necessary for setting priorities for public health in targeted interventions to reduce the severity of risk [14] . Initial studies reported an estimation of 3% for the global CFR of COVID-19 [15] . Estimating CFR from country-level data requires assessment of information about the delay between the report of the country-specific cases and death from COVID-19, as well as underestimating and under-reporting of death-related cases, which may not be known. Given the importance of CFR and recovery rate (RR), in this current study the CFR and RR of different countries during a COVID-19 ongoing pandemic was observed using up-to-date countrylevel data. The data were retrieved from accurate databases including Worldometer 2, WHO 3, the Center of Disease Control and Prevention [16] , and the Morbidity and Mortality Weekly Report series (provided from Center of Disease Control and Prevention), according to the user's guide of data sources for patient registries [17] . Due to the rapid increase in data, the analysis in this study was performed on the 12 th and 23 rd of March 2020. Raw data was mapped according to countries and CFR and RR were compared for countries with ≥ 1,000 cases. All countries with < 1,000 cases are presented in supplementary Table 1 . A comparison of CFR with different known viral diseases was performed. The formulas below were used to measure CFR and RR. The total number of confirmed cases of COVID-19 was highest in China, followed by Italy and Iran on 12 th March, but on 23 rd March 2020, total COVID-19 confirmed cases was the highest in China, followed by Italy, USA, and Spain (Table 1) . However, Italy's CFR was the highest on both time points (12 th Only countries with total cases over 1,000 are depicted (population in million and GDP in trillion US dollars). GDP = gross domestic product; ICU = intensive care unit. The outbreak was declared a public health emergency of international concern on 30 th January 2020 [18] . Confronting The data from this study supports the fact that the CFR of the COVID-19 pandemic seems to be less than Bird flu, Ebola, SARS, and MERS, but public health concerns remain due to its highly infectious nature, since a large proportion of cases are asymptomatic or mild, which promotes the spread of the disease worldwide. In such situations, the media plays a crucial role in promoting health literacy and advocating limited spread of the disease [19] . Death and severity of COVID-19 are associated with age and comorbidities across the world. Especially in countries with the highest outbreaks, such as China, Italy, and Iran, strategies must be employed to ensure that high-risk groups, such as old people and those with other underlying diseases such as diabetes and cancer, received adequate protection from COVID-19. Therefore, early access to medical care when infected is vital for improving chances of survival. Improving medical supplies to countries such as Iran, which is significantly influenced by US punitive policies, can reduce the deterioration of this politically sensitive situation [20] . disease. The authors have no conflict of interest to declare. 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