|Year : 2022 | Volume
| Issue : 2 | Page : 175-181
Infection and case fatality rate of COVID-19 in 100 countries: A comparative study based on economic status
Rafiuddin Mohammed1, Javed Khan2, Salah Alshagrawi2
1 Department of Health Informatics, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
2 Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
|Date of Submission||05-Sep-2021|
|Date of Decision||16-Nov-2021|
|Date of Acceptance||24-Feb-2022|
|Date of Web Publication||28-Apr-2022|
Department of Health Informatics, College of Health Sciences, Saudi Electronic University, P. O. Box: 93499, Riyadh 11673
Source of Support: None, Conflict of Interest: None
Objectives: The purpose of the study was to determine COVID-19 infection rate (IR) and case fatality rate (CFR) among the economic status of the countries. Methods: First 100 countries, according to the highest number of COVID-19 cases recorded as of August 14, 2021, were included in the present study and were classified as high-income (38), upper-middle-income (37), and low-middle-income (25) countries. The data were extracted from the Worldometer website tracking of COVID-19 cases globally. All parameters in this study are expressed as frequencies and percentages. IR and CFR were tabulated using specific formulations. Results: In high-income countries, Czechia (15.62%) and Bahrain (15.32%) reported the highest IR, whereas Hungary (3.71%) and Slovakia (3.19%) reported the highest CFR. In upper-middle-income countries, Georgia (11.99%) and Argentina (11.13%) with the highest IR, followed by Peru (9.25%) and Mexico (8.06%) resulted in the highest CFR. In lower-middle-income countries, Moldova (6.55%) and Palestine (6.12%) reported the highest IR. Egypt (5.82%) and Afghanistan (4.62%) observed the highest CFR of COVID-19. When comparing the economic status, found IR highest among high income countries (7.60%), whereas upper middle income countries showed the highest CFR (2.73%). Interestingly, found the lowest CFR in Qatar (0.26%) and UAE (0.29%) among all countries. Conclusions: Based on the comparison, different countries have responded better than other countries irrespective of the financial and economic status of these countries. The results showed high-income countries are the worst affected by the COVID-19 pandemic. The result of this preliminary study can be used as a benchmark for authorities in the administration of the policies according to the economic status.
Keywords: High-income, infection rate and case fatality rate, low-middle-income, upper-middle-income
|How to cite this article:|
Mohammed R, Khan J, Alshagrawi S. Infection and case fatality rate of COVID-19 in 100 countries: A comparative study based on economic status. J Nat Sci Med 2022;5:175-81
|How to cite this URL:|
Mohammed R, Khan J, Alshagrawi S. Infection and case fatality rate of COVID-19 in 100 countries: A comparative study based on economic status. J Nat Sci Med [serial online] 2022 [cited 2022 May 21];5:175-81. Available from: https://www.jnsmonline.org/text.asp?2022/5/2/175/344201
| Introduction|| |
The COVID-19 pandemic has distressed every human being's standard of living, an unexpected increase of patients in hospitals leading to hospital systems collapse and creating economic crises in many countries of the world. As of August 14, 2021, there have been more than 207,723,303 confirmed COVID-19 cases and more than 4,371,455 deaths around the globe. This pandemic observed an infinite extent of mortality rate with different variants of COVID-19 around the world. The resulting impact of the COVID-19 pandemic lost millions of lives and global debt with trillions of dollars facing many countries. Even after vaccination programs globally, herd immunity appears to be more intriguing. In spite of the high vaccination rate, the pandemic is not yet over and seems to continue reporting cases globally. Experts believe vaccination alone may not work, instead of focusing more on health care, commerce, and political issues with new approaches to overcome the challenges. Many governments within the countries are re-enforcing new regulations, restrictions, and hefty fines due to noncompliance with the regulation because of high infection rate (IR) transmissions. This led to once again shutting down all the public and governmental institutions to control COVID-19 spread.
With the movement of people within and around the globe, several nations miserly see the cases rising again while facing different waves of COVID-19. This leads to increased infection and mortality rates within these countries. There is a crucial need to scrutinize the epidemiology with respect to infection and case fatality rate (CFR). An extensive review of the literature regarding COVID-19 economic status resulted in only one publication. Therefore, the present study is to examine COVID-19 IR and CFR among the economic status of the countries.
| Methods|| |
The study was retrospective and included data from the first 100 countries according to the highest number of COVID-19 cases recorded as of August 14, 2021. These countries were divided into three categories as high-income, upper-middle-income, and low-middle-income countries (including low-income countries) according to the World Bank classification of countries. The gross national income is the main benchmark for classifying economies among these countries' differences. Afghanistan, Ethiopia, Mozambique, and Nepal are classified as low-income countries; however, they are included in low-middle-income countries in the statistical analysis. All age groups with both male and female individuals diagnosed with COVID-19 infection within the first 100 countries as of the given date were included in the study, and the rest of the countries were excluded from the study. Three parameters of data such as total cases, total death, and population were extracted from the Worldometer website tracking of COVID-19 cases globally. These cases were also compared to check the conformity with the World Health Organization COVID-19 dashboard of each country. Owing to epidemiological surveillance differences in each country, the number of confirmed cases might be altered due to the update on the dashboard because of time differences in each country. The study does not require any participants consent, and the Saudi Electronic University Research Ethics Committee waived the present study as the data were conjugated from available websites of the COVID-19 dashboard. A Statistical Package for Social Sciences Version 20 (SPSS Inc., Chicago, IL, USA) was utilized for data analysis. All parameters in this study were expressed as frequencies and percentages. Further, the present study included 38, 37, and 25 countries from high-income, upper-middle-income, and low-middle-income countries, respectively. The IR was tabulated using the formula: Total number of cases multiplied by the total population of the country into hundred. Whereas CFR: Total number of deaths multiplied by the total number of cases reported each country into hundred.
| Results|| |
[The descriptive statistics of COVID-19 data of the number of cases and death according to the economic status are shown in [Table 1]]. The highest IR of COVID-19 reported in high-income countries is Czechia (15.62%) and Bahrain (15.32%) in a given population. Whereas CFR showed the highest among the countries of Hungary (3.71%) and Slovakia (3.19%). Interestingly, it reported the lowest CFR in Qatar (0.26%) and UAE (0.29%). [Figure 1] shows the percentage of COVID-19 comparisons of IR and CFR between the high-income countries. Georgia (11.99%) and Argentina (11.13%) and Peru (9.25%) and Mexico (8.06%) reported the highest IR and CFR, respectively, among upper-middle-income countries. [Figure 2] shows the percentage of COVID-19 comparisons of IR and CFR between the upper-middle-income countries. In lower-middle-income countries, Moldova (6.55%) and Palestine (6.12%) reported the highest IR. Egypt (5.82%) and Afghanistan (4.62%) observed the highest CFR of COVID-19. [Figure 3] shows the percentage of COVID-19 comparisons of IR and CFR between the lower-middle-income countries. When comparing the economic status, found IR highest among high income countries (7.60%), whereas upper-middle-income countries showed the highest CFR (2.73%). [Figure 4] shows the percentage of COVID-19 comparisons of case fatality and IR between the economic status of the countries.
|Table 1: Descriptive statistics of COVID-19 cases and death in three different economic countries|
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|Figure 1: Percentage of COVID-19 comparisons of infection rate and case fatality rate between the high-income countries|
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|Figure 2: Percentage of COVID-19 comparisons of infection rate and case fatality rate between the upper-middle-income countries|
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|Figure 3: Percentage of COVID-19 comparisons of infection rate and case fatality rate between the lower-middle-income countries. Note: Afghanistan, Ethiopia, Mozambique, and Nepal are low-income countries|
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|Figure 4: Percentage of COVID-19 comparisons of infection rate and case fatality rate between the economic status of the countries|
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| Discussion|| |
The COVID-19 is spreading rapidly and proceeding the health-care system in different countries of the world under stress leading both public health and an economic crisis globally. These countries have performed differently to the virus outbreak to control its spreading but limited achievements. The present study determines the IR and CFR of COVID-19 spread in 100 counties according to the economic status of the World Bank classification system. The study reported the highest IR in Czechia (15.62%) and Bahrain (15.32%) and CFR in Hungary (3.71%) and Slovakia (3.19%) among the high-income countries sequentially [Figure 1]. The present study results are consistent when it comes to coronavirus deaths per capita that showed that Czechia had the highest coronavirus IR in the world. Even though Czechia had a good health-care system and an average economy, the epidemiology experts and analysts blame the populist government country's catastrophic highest IR record. Lack of testing capacity, inadequate infection tracking, and obesity among the population are the possible factors for the high death rate. Currently, Czech hospitals and the economy are on the brink of collapse. As a wealthy nation and being a member of the European Union, which has access to vaccines, medical equipment, and an absolute health-care system with advanced technologies, there is no reason to be among the worst-hit countries. Bahrain showed the second-highest IR in the given population among the high-income countries, but its CFR is remarkably low which is 0.51 among the confirmed COVID-19 cases. These results support similar findings that reported the highest IR in Bahrain compared within GCC countries. Bahrain had taken early measures such as strict lockdown, intensified mass testing among the population, and tracing the COVID-19 patients at early stages. Furthermore, the availability of intensive care capacity in hospitals and allocating additional funding for the health-care sector are factors for the lowest CFR among populations of Bahrain. Bahrain also topped the list when it came to mass vaccination campaigns of two doses administered per 100 people reporting the lowest death rate.
The current study also revealed the highest CFR among COVID-19 patients in Hungary (3.71%) and Slovakia (3.19%) compared to other countries within the high-income countries [Figure 1]. Hungary has the highest number of daily COVID-19 deaths per 1 million people and has surpassed Belgium, the United States, Spain, the United Kingdom, and Italy., Even Slovakia was grappling with surging COVID-19 cases, leaving doctors and nurses battling for the lives of those infected with the virus and records the world's highest COVID-19-related death rate. Despite vaccination success, the UK variants being present in large numbers of people unknowingly causing mortality rate to a greater extent. The possible factors according to the experts believe that not enough PCR tests were conducted, shortage of workers in the health care and lack of quick action by the governments resulted in the spread of the UK coronavirus variant which initiated different waves resulting in more deaths., A global meta-analysis showed that comorbidities are another reason why the death toll in the developing world is higher. One of the interesting findings in the study showed Qatar (0.26%) and UAE (0.29%) lowest CFR among the high-income countries. These two oil-rich nations tested more, and the tracing process with great speed resulted in apparently lower CFR. In addition, the younger age of the population including health care spending also played a crucial role in the lower death rate.
In the upper-middle-income countries, the present study noted Georgia (11.99%) and Argentina (11.13%) have the highest IR [Figure 2]. Both in Georgia and Argentina, COVID-19 infections and hospitalizations continue to rise rapidly with the majority of hospitals completely filled with infection patients leading hospitals close to collapse., In Latin America, Argentina alongside Brazil and Colombia surpassed 3 million coronavirus cases. However, Argentina imposed strict lockdowns such as suspending social, business, educational, religious, and sporting activities but is still seen in rises of COVID-19 cases. This led to a negative impact on the economy of the country. Furthermore, due to insufficient vaccines and contagious variants of the virus, the health sector was positioned on the verge of crumbling. The current study results found Peru (9.25%) and Mexico (8.06%) have one of the highest CFR in upper-middle-income countries [Figure 2]. The results support a similar finding that Peru has more than doubled its COVID-19 death toll making it the country with the world's highest death rate per capita. Whereas in Mexico, thousands of patients are dying every week without access to intensive care. Feasibly, due to leadership failure, slow vaccine rollout process, poor health-care system, lack of oxygen supplies, overcrowding in homes and public places, and inappropriate planning by the health expert resulted in the highest mortality rate.,,
In lower-middle-income countries, Moldova (6.55%) and Palestine (6.12%) reported the highest IR [Figure 3]. However, when compared to high- and upper-middle-income countries, the percentage is positively very low. The acceleration of COVID-19 IR in Moldova due to the Orthodox Church festival raises fears of a second wave of the coronavirus. Among the poorest countries in Europe, Moldova also has one of the highest rates of infection among medical staff in the world. The European Union proclaims an economic recovery plan for Moldova to regain from the COVID-19 crisis in the country. Ultimately, this financial support strengthens solidarity to fight together with the COVID-19 pandemic. Whereas the situation in Palestinian territories has worsened after discovering delta variants that needed many patient hospitalizations. The Businessmen Association in Gaza estimated the economic losses due to the consequences of the COVID-19 crisis at more than $1 billion. With unprecedented rates of poverty and unemployment in Palestine, COVID-19 worsened the treatment process. Egypt (5.82%) and Afghanistan (4.62%) showed the highest CFR among low-income countries [Figure 3]. The results are consistent with a similar study that reported Egypt seventh country in the world with a CFR of 5.92%. The reason for the low prevalence and high fatality rate in Egypt is cases undetected and homely recovered. Furthermore, Egypt is a particularly flagrant example of the extreme cover-up of COVID-19 cases distrust by many expert observers. In contrast, Afghanistan is a war-torn nation and one of the poorest countries where half of its population lives below the poverty line. Due to the lack of the national death register, cases and mortality might be underreported overall. Recently, Taliban took over the Afghanistan's control after the collapse of government with the leftover of America's army, which might further deteriorate the situation leading to an increase in cases and mortality. Currently, humanitarian aid and donations are possible solutions to control the spread of diseases in Afghanistan.
The COVID-19 crisis had differential impacts among various countries with income and wealth. When compared to the economic status of these countries, the analysis of the results showed IR highest among high-income countries (7.60%), whereas the highest CFR (2.73%) was observed in upper-middle-income countries [Figure 4]. The higher IR could be failure or lack of mass testing, inadequate social distance measures, delay in public health response, and the relaxation of restrictions are behind the rapid spread of the virus in the countries.,, Possible factors for the highest mortality rate due to obesity, the proportion of the population over the age of 65 and urbanization as a measure of density had a statistically significant positive effect on the COVID-19 mortality rate.,, Low-income countries have the lowest infection and CFR which is one of the significant findings in the current study. These results support a similar finding that per capita income countries had significantly negative effects on COVID-19.
One of the limitations of the study is that it is being conducted during an ongoing pandemic and as such the data are subject to change over time. The data collected in this study are based on the COVID-19 dashboard statistics reporting of various cases, must agree to the given data as the fact even though the highest quality of data may still be far from absolute representations around the countries.
| Conclusions|| |
Based on the comparison, different countries have responded better than other countries irrespective of the financial and economic status of these countries. The results showed high-income countries are the worst affected by the COVID-19 pandemic. There are differences in the infection and CFR of COVID-19 among different countries; political decision-making, scientific advice, and health system and public health capacity may have played crucial roles in the management of COVID-19 pandemic. It is beyond the scope of this article to determine the differences within each country according to their economic classification system. The result of this preliminary study can be used as a benchmark for authorities to formulate the policies according to the economic status.
The authors thank the World Health Organization and Worldometer for the availability of COVID-19 data according to each country.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]