Finding the real COVID-19 case-fatality rates for SAARC countries

Abstract

The crude case fatality rate (CFR), because of the calculation method, is the most accurate when the pandemic is over since there is a possibility of the delay between disease onset and outcome. Adjusted crude CFR measures can better explain the pandemic situation by improving the CFR estimation. However, no study has thoroughly investigated the COVID-19 adjusted CFR of the SAARC countries. This study estimated both survival interval and underreporting adjusted CFR of COVID-19 for these countries. Moreover, we assessed the crude CFR between genders and across age groups and observed the CFR changes due to the imposition of fees on COVID-19 tests in Bangladesh. Using the daily records up to October 9, we implemented a statistical method to remove the delay between disease onset and outcome bias, and due to asymptomatic or mild symptomatic cases, reporting rates lower than 50% (95% CI: 10%–50%) bias in crude CFR. We found that Afghanistan had the highest CFR, followed by Pakistan, India, Bangladesh, Nepal, Maldives, and Sri Lanka. Our estimated crude CFR varied from 3.708% to 0.290%, survival interval adjusted CFR varied from 3.767% to 0.296% and further underreporting adjusted CFR varied from 1.096% to 0.083%. Furthermore, the crude CFRs for men were significantly higher than that of women in Afghanistan (4.034% vs. 2.992%) and Bangladesh (1.739% vs. 1.337%) whereas the opposite was observed in Maldives (0.284% vs. 0.390%), Nepal (0.006% vs. 0.007%), and Pakistan (2.057% vs. 2.080%). Besides, older age groups had higher risks of death. Moreover, crude CFR increased from 1.261% to 1.572% after imposing the COVID-19 test fees in Bangladesh. Therefore, the authorities of countries with higher CFR should be looking for strategic counsel from the countries with lower CFR to equip themselves with the necessary knowledge to combat the pandemic. Moreover, caution is needed to report the CFR.

District-Level Risk Factors for COVID-19 Incidence and Mortality in Nepal

“…As of 16 September 2020, a total of 58,327 cases were reported, and cases reached 268,948 on 22 January 2021 (end of the study) [ 14 ]. Despite a rapid spread of COVID-19, Nepal had high recovery rate, about 98%, as of 22 January 2021 [ 15 ], and a relatively low case fatality rate (CFR); the CFR was 0.6% up to 8 October 2020 [ 16 ].…”

Epidemiological investigation of the COVID-19 outbreak in Vellore district in South India using Geographic Information Surveillance (GIS)

“…The case fatality rate in our study population was 1.89% and 1.6% during the first wave and second wave respectively. A study published by Shah et al, found that the CFR for SAARC countries were lower than the developed countries and the estimated crude and adjusted CFR for India was 1.542% and 1.601% (95% CI 1.548 -1.684) during the first wave (Shah et al, 2021). Another study by Bogam et al, estimated that the fatality rate was 12 47% lower in the delta variant driven second wave than in the first wave (adjusted CFR 0.43; 95% CI 0.41 -0.45) (Bogam et al, 2021) despite the large numbers.…”

Overview of coronavirus pandemic

“…Different factors have been studied (younger population, previous exposure to other Coronaviruses that provides immunity, genetic differences, hygiene etiquette, lower infectious load, etc.) without reaching a clear conclusion: probably, having a young population influences, but on the other hand, comorbidities, poverty, frailty malnutrition, and congested urban living may have an adverse effect on risk that may increase both rates ( Ioannidis, 2021 , Shah et al, 2021 ).…”