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

Area of Science:

• Epidemiology
• Public Health

Background:

• Crude case fatality rate (CFR) calculations for COVID-19 are often inaccurate due to reporting delays and underascertainment.
• Previous studies have not comprehensively assessed adjusted CFR for the South Asian Association for Regional Cooperation (SAARC) countries.

Purpose of the Study:

• To estimate survival interval and underreporting adjusted CFR of COVID-19 for SAARC countries.
• To analyze CFR variations by gender and age group.
• To examine the impact of COVID-19 testing fees on CFR in Bangladesh.

Main Methods:

• Utilized daily COVID-19 records up to October 9.
• Implemented statistical methods to correct for disease onset-outcome delays.
• Adjusted for underreporting bias, estimating reporting rates between 10%-50%.

Main Results:

• Afghanistan exhibited the highest CFR, followed by Pakistan, India, Bangladesh, Nepal, Maldives, and Sri Lanka.
• Estimated crude CFR ranged from 3.708% to 0.290%, adjusted CFRs from 3.767% to 0.296%, and underreporting adjusted CFRs from 1.096% to 0.083%.
• Higher CFR observed in males in Afghanistan and Bangladesh; older age groups faced greater mortality risk. Bangladesh's CFR rose post-testing fee implementation.

Conclusions:

• Countries with higher COVID-19 CFR can learn from those with lower rates to improve pandemic response.
• Accurate CFR reporting requires careful consideration of adjustment methods.