One of the ways in which the burden of any disease is measured is by seeing how many deaths it is causing. In the case of COVID-19, which has now infected over 30 lakh people in 185 countries and regions and killed close to 2.1 lakh, this burden has varied widely — countries have reported very different case fatality ratios (CFR), which is the number of deaths divided by the number of confirmed cases.
While many things about the novel coronavirus remain unknown, broadly speaking, CFR depends on three broad factors:
First is the number of people tested. Testing rates have been different in different countries — India continues to be among the countries where testing is widely seen to be inadequate. More aggressive testing identifies more asymptomatic infected persons, and people with milder, less noticeable symptoms. Since CFR relies on the number of confirmed cases (which is a specific number) and not the total number of cases (which can only be an estimate), more testing lowers the ratio.
The second factor is demography. As a general principle, any virus poses a greater threat to those with weaker immunities, and a vast majority of deaths from COVID-19 have been of people with co-morbid conditions. Older people are more vulnerable; indeed, the virus has wreaked the greatest havoc in populations that are older.
Finally, the strength and capacity of healthcare systems matter greatly. Countries like Italy or Spain saw their hospitals overwhelmed, and unable to adequately care for the flood of patients. In India, where resources are limited and critical care capacities constrained, the danger from an uncontrolled spread is that much greater.
In absolute numbers, the US carries the greatest burden of COVID-19, accounting for nearly a third of all cases. Spain and Italy follow, together accounting for over 14% of global cases.
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In terms of observed CFR, a different set of countries leads the chart. According to the Johns Hopkins University coronavirus resource centre dashboard, the highest mortality is in Belgium (15.4%), followed by France (14.1%) and the UK and Italy (13.5% each). The CFR of the US is 5.7%.
Belgium’s deaths per 1 lakh population are 62.11, the highest in the world, followed by Spain (49.63), Italy (44.09) and France (34.17).