The importance of COVID-19 testing to assess socioeconomic fatality drivers and true case fatality rate. Facing the pandemic or walking in the dark?

Abstract

Up to date, European and other developed countries became the centre of the pandemic. While the COVID-19 spread to developing countries and less developed regions, seems to be still very low. The Case Fatality Rate (CFR) differs a lot among countries, genetics, health systems, population characteristics as well as public health and social measures (lockdown measures) are believed to be the determinants of such diversity. Through an Ordinal Probit, Cross Section and Panel data models for 71 countries, it is shown that the nations applying more tests per million inhabitants are also those reporting more cases and deaths, yet greater testing helped to reduce CFR; while, health infrastructure and population health indicators could not be confirmed as drivers for CFR. The Stringency Index showed a negative correlation with the number of deaths. Our main finding is that, the pandemic concentration on developed nations is highly related with their ability and resources for tracking the pandemic. Three additional conclusions are drawn: first, the true CFR and its drivers at national levels cannot be estimated without increasing the number of tests per million inhabitants; second, there is an under-identification of cases and/or deaths and the countries applying more tests, are most clearly identifying the reality of the pandemic, while countries with less cases, are actually still walking in the dark; third lockdown measures have been effective at reducing the number of deaths.