Epidemiological Measures in the Context of the COVID-19 Pandemic

Abstract

A 76-year-old otherwise healthy man was delivered by ambulance to the emergency room with a 4-day history of fever (up to 39°C), a dry cough, and diarrhea. The main clinical findings were tachypnea and respiratory insufficiency (SpO2 93%, 15 L oxygen with reservoir mask). Laboratory tests detected elevated concentrations of C-reactive protein (86 mg/L) and lactate dehydrogenase (431 U/L); the procalcitonin level was normal. Pulmonary sonography at the bedside revealed areas of jagged fragmentary pleural line with partially confluent B lines, particularly in the upper anterior portion of the left lung; lung sliding was present (Figure a). In adjacent lung areas the sonographic findings were normal. A consolidation with liver-like echo texture and air bronchogram was visualized in the right costophrenic angle (Figure b). A pleural effusion was also seen. This pattern on pulmonary sonography is currently considered indicative of COVID-19 viral pneumonia. Computed tomography confirmed the morphological findings, with ground-glass opacities concentrated in the left upper lobe and a consolidation in the right lower lobe. Despite intensive treatment the patient developed severe acute respiratory distress syndrome and multiorgan failure. He died on day 14 after admission.

The Role of Age Distribution, Time Lag Between Reporting and Death and Healthcare System Capacity in Case Fatality Estimates of COVID-19

“…A distinction must be made between factors that in uence the actual lethality (as denoted by * ), such as healthcare capacity and those that bias the estimates of the CFR, such as an underassessment of cases. Higher CFR given an older population with a higher load of comorbidities (3)(4)(5)(6)(7)(8)(9)(10)(11) Surveillance and testing Surveillance system and different testing capacities…”

“…Underestimation of CFR given a time lag of several days between case registration and death resulting in a smaller nominator of current deaths / current infected (11,21) Healthcare system * Healthcare system capacity measured as number of intensive care beds per 100.000 inhabitants Higher CFR given a low healthcare capacity and an additional excessive demand for intensive care beds during the pandemic resulting in more deaths and therefore a higher numerator of deaths / current infected (4,17,(22)(23)(24)(25)(26) Different demographic characteristics of infected cases regarding age, comorbidities, or underlying risk factors, as well as different underlying population structures of the respective countries, might explain different CFRs. There is increasing evidence that old-age and comorbidities -such as hypertension, diabetes, cardiovascular disease, or chronic lung disease -are major risk factors for severe COVID-19 infection outcomes (6,27,28).…”

“…However, as a result of the high transmission rates of the virus in the early stages of the epidemic, the estimates depend strongly on the appropriate lag, and both under-and overestimation of the true CFR can occur (32). Gianicolo et al (11) calculate age-standardized CFRs with a time lag of 7 days ranging from 0.8% in South Korea to 2.4% in Italy. In contrast, they report crude CFRs of 2.2% for South Korea and 12.6% for Italy.…”

The Epidemiological and Spatio-temporal Characteristics of 2019 Novel Coronavirus Diseases (COVID-19) in Libya

“…Countries like, Sweden, and Germany responded early and successfully. Though others such as Italy, Spain and France, the action was different and thus it resulted in a high number of deaths [2][3][4] . The impact was even worse in developing countries such as Iran and Brazil as the early action was improper and in uenced by virtual local understanding [5,6].…”

The Epidemiological and Spatiotemporal Characteristics of 2019 novel coronavirus diseases (COVID-19) in Libya

“…Countries , such as Sweden and Germany responded early and successfully. Though others such as Italy, Spain and France, the action was different and thus resulted in a high number of deaths [2][3][4]. The impact was even worse in developing countries such as Iran and Brazil, as early action was improper and in uenced by virtual local understanding [5,6].…”