Which country has the lowest case-fatality rate of COVID?

Since December 2019, the COVID-19 pandemic has plagued the world for more than a year now. The total number of confirmed cases has passed the 10 million mark, and the death toll has reached 2.44 million. The current global case-fatality ratio (CFR) is about 2.2%.

CFR is defined as the number of deaths divided by the number of confirmed cases.

The good news is the daily number of confirmed cases around the world has shown an obvious sign of decline. Figure 1 shows that the daily number of confirmed cases has dropped from the peak of 733,764 cases on January 12, 2021 to 360,639 cases on February 18, 2021. It fell by 51% in just a month. Hope it will continue the rate of decline.

Figure 1 The number of daily confirmed cases of COVID-19 worldwide, source: https://ourworldindata.org/coronavirus/country/

However, the decline in mortality is normally lagging behind, it may take a few more days to confirm the trend. The latest data as shown in Figure 2 shows that the number of deaths per day is declining from the height of 14,374 cases on January 26, 2021to below 10,000 (9,866) cases on Feburary 18, 2021. It has fallen by 31% in less than a month, but it is still at a high level.

Figure 2 The daily number of new deaths from COVID-19 worldwide, source: https://ourworldindata.org/coronavirus/country/

Comparing the two figures, the number of deaths is not straightly proportional to the number of confirmed cases, although the two are still roughly positively correlated. The reason is probably due to the differences in the case-fatality ratios in different countries. The lack of experience in the treatment of the new disease in the early stage and the sudden increase in the number of confirmed cases might overload the hospitals, causing a higher proportion of the early number of deaths to the number of confirmed cases. For example, in April last year, the case-fatality ratio was more than 7% which is three times of the current global average of 2.2% (Figure 3).

Figure 3 The case-fatality ratio of COVID-19 worldwide, source: https://ourworldindata.org/coronavirus/country

It is true that the recovery rate of patients can be related to many factors, including the provisions of the medical services, sufficiency of medical staff, number of confirmed cases, or even local climate. It is not yet certain why the recovery rate of some countries is much better than the global average. Some research institutes have drawn scatterplots of the cumulative case-fatality ratios of COVID-19 in various countries, and found a very obvious linear positive correlation (Figure 4 — Note that the number of deaths on the vertical axis is on a log scale), and the figure clearly shows the case-fatality ratio of some countries are not only lower than the global average of 2.2%, but they are even lower than 0.5%, and there is only one country that is so far 0% (the yellow dot far right to the 0.5% line in the figure)!

Figure 4 The scatterplot of the cumulative case-fatality ratios of COVID-19 in various countries, source: https://coronavirus.jhu.edu/data/mortality

From the data, it is found that only eight countries have a case-fatality ratio less than 0.5%. Figure 5 shows the cumulative number of confirmed cases (second column), the cumulative number of deaths (third column), and the case-fatality ratio (fourth column) in these eight countries. Many of them are located in the Middle East or Southeast Asia. Among them, only one country has been able to maintain a zero case-fatality ratio — Singapore. There are a total of 29 people died from COVID-19 in Singapore so far, the proportion of the total number of deaths to confirmed cases is the lowest in the world. The case-fatality ratio is 0.0485%, and so it is reported to be 0.0% after rounding up!

Figure 5 Eight countries’ data with the lowest case-fatality ratios on February 18, source: https://coronavirus.jhu.edu/data/mortality

In February last year, I published three articles (Yiu, 2020a, b, c) about Singapore’s higher and faster recovery rate from COVID-19. It is estimated to be related to their medical system, but I have not seen any other relevant reports or research on it. But then when the number of confirmed cases in Singapore skyrocketed, the report of the daily number of recoveries was no longer produced from the local news, so it was impossible for me to follow up.

After one year, we learn that the number of confirmed cases in Singapore is quite large (there are almost 60,000 confirmed cases so far), but the recovery rate is higher than 99.9%! It confirms my analysis and findings a year ago. I hope that in the future, some research teams can investigate more about the cases of Singapore and the other seven countries on the factors contributing to their high recovery rates. If the research results can be shared with the world, more people in other countries can avoid the tragedies.

References:
Yiu, C.Y. (2020a) The recovery period of Wuhan pneumonia patients in Hong Kong is longer than that in Singapore, February 13. [in Chinese] https://vocus.cc/eyanalysispoliecon/5e446dfffd89780001c2f744
Yiu, C.Y. (2020b) Is Singapore seeing results in the treatment of Wuhan pneumonia? February 14. [in Chinese] https://vocus.cc/eyanalysispoliecon/5e471aeafd8978000199933b
Yiu, C.Y. (2020c) Singapore is expected to control the COVID-19 epidemic, February 25. [in Chinese] https://vocus.cc/eyanalysispoliecon/5e547ae2fd8978000140a7ed

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