Global trends in COVID-19 incidence and case fatality rates (2019-2023): a retrospective analysis.

Objectives: Analyzing and comparing COVID-19 infection and case-fatality rates across different regions can help improve our response to future pandemics. Methods: We used public data from the WHO to calculate and compare the COVID-19 infection and case-fatality rates in different continents and income levels from 2019 to 2023. Results: The Global prevalence of COVID-19 increased from 0.011 to 0.098, while case fatality rates declined from 0.024 to 0.009. Europe reported the highest cumulative infection rate (0.326), with Africa showing the lowest (0.011). Conversely, Africa experienced the highest cumulative case fatality rates (0.020), with Oceania the lowest (0.002). Infection rates in Asia showed a steady increase in contrast to other continents which observed initial rises followed by decreases. A correlation between economic status and infection rates was identified; high-income countries had the highest cumulative infection rate (0.353) and lowest case fatality rate (0.006). Low-income countries showed low cumulative infection rates (0.006) but the highest case fatality rate (0.016). Initially, high and upper-middle-income countries experienced elevated initial infection and case fatality rates, which subsequently underwent significant reductions. Conclusions: COVID-19 rates varied significantly by continent and income level. Europe and the Americas faced surges in infections and low case fatality rates. In contrast, Africa experienced low infection rates and higher case fatality rates, with lower- and middle-income nations exceeding case fatality rates in high-income countries over time.

The Impact of the Novel Coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic on Case Fatality Rates and Cost of Surgical Care in Brazil.

Background The coronavirus disease 2019 (COVID-19) pandemic provoked disruptions in healthcare delivery. Following the recommendations of major surgical societies and surgical departments globally, most surgeries were widely canceled or postponed, causing significant disruptions to healthcare delivery worldwide, including in Brazil. Brazil's public healthcare system - Sistema Único de Saúde (SUS) was particularly affected, with a substantial decline in elective procedures, especially during the pandemic's early stages. The impact of the pandemic on surgical services in Brazil has not been adequately studied since most studies only cover the early phases of the pandemic. Thus, this study aims to analyze the case fatality rates and costs, associated with the different surgical procedure subgroups performed during the pre-pandemic, pandemic, recovery, and post-pandemic periods in all five regions of Brazil. Methods A retrospective cross-sectional design was used to examine surgical cases from 2019 to 2022. Data was divided into four time periods, named as the pre-pandemic (March-December 2019), pandemic (March-December 2020), recovery (March-December 2021), and post-pandemic (March-December 2022), and was analyzed for the cost of surgical procedures in the aforementioned four periods. In addition, the case fatality rates and rate ratios in the four periods stratified according to region were calculated. Results The cost of surgical procedures decreased during the pandemic and recovery period compared with pre-pandemic for all procedures except thoracic surgery where it was higher in the recovery period than pre-pandemic. No statistically significant change in cost was observed in surgeries of the central and peripheral nervous system, circulatory system, obstetric, and oncology. Case fatality rates increased among all five regions of Brazil in pandemic and recovery periods compared to pre-pandemic and post-pandemic periods. Case fatality rates increased during the pandemic and/or recovery as compared to pre-pandemic in all procedures except visual apparatus and obstetric surgeries were not affected by the pandemic in terms of case fatality rates. Conclusion The COVID-19 pandemic had a significant impact on surgical care costs and case fatality rates for surgery in Brazil. There was a decreasing trend in the costs of procedures during the pandemic, followed by a gradual recovery to baseline values, except for thoracic surgery. Case fatality rates rose initially and then declined, ultimately reaching baseline levels. The pandemic posed significant challenges to the healthcare system, affecting medical services, including surgical care.

Amniotic fluid embolism: 20-year incidence and case-fatality trends in the United States.

OBJECTIVE: To estimate incidence and case-fatality rates of amniotic fluid embolism (AFE) and to examine their temporal trends. STUDY DESIGN: Population-based retrospective cohort study using the 2000-2019 Health Care Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). Annual population rates were estimated using HCUP-NIS specific weighting. Descriptive analyses and logistic regression described trends within the cohort. RESULTS: Over the study period, AFE incidence rate remained stable (mean 4.9 cases/100,000 deliveries) and the case-fatality rate declined (mean 17.7 %,95 % CI 16.40-10.09). Highest AFE incidence rates and fatality rates were in women ≥ 35 years, African-Americans, and in urban-teaching hospitals. AFE mortality rates decreased among Hispanics. CONCLUSION: AFE rates remained stable and fatality rates declined over time. Highest rates of AFE occurrence and death were in women who typically have greater risk of experiencing adverse obstetrical outcomes. Continued research into early diagnostic methods and effective treatments are needed to further improve AFE incidence and mortality rates.

A Sequential Cross-Sectional Analysis Producing Robust Weekly COVID-19 Rates for South East Asian Countries.

The COVID-19 pandemic has expanded fast over the world, affecting millions of people and generating serious health, social, and economic consequences. All South East Asian countries have experienced the pandemic, with various degrees of intensity and response. As the pandemic progresses, it is important to track and analyse disease trends and patterns to guide public health policy and treatments. In this paper, we carry out a sequential cross-sectional study to produce reliable weekly COVID-19 death (out of cases) rates for South East Asian countries for the calendar years 2020, 2021, and 2022. The main objectives of this study are to characterise the trends and patterns of COVID-19 death rates in South East Asian countries through time, as well as compare COVID-19 rates among countries and regions in South East Asia. Our raw data are (daily) case and death counts acquired from "Our World in Data", which, however, for some countries and time periods, suffer from sparsity (zero or small counts), and therefore require a modelling approach where information is adaptively borrowed from the overall dataset where required. Therefore, a sequential cross-sectional design will be utilised, that will involve examining the data week by week, across all countries. Methodologically, this is achieved through a two-stage random effect shrinkage approach, with estimation facilitated by nonparametric maximum likelihood.

Sex differences in temporal trends in main and secondary pulmonary embolism diagnosis and case fatality rates: 2003-2019.

AIMS: There is controversy regarding the incidence and outcomes of pulmonary embolism (PE) according to sex. Our aim was to address sex differences in temporal trends in main and secondary hospital PE diagnoses, management and case fatality rates (CFR). METHODS AND RESULTS: Retrospective analysis of Spain´s National Healthcare System hospital database, years 2003-2019, for patients ≥18 years with main or secondary PE diagnosis. Trends by sex in hospital diagnosis, use of procedures, and CFRs were analysed by joinpoint and Poisson regression models. Of 339 469 PE diagnoses, 52% were in women. Sixty-five percent were main diagnosis, 35.2% secondary. Total annual diagnoses and frequentation rates increased similarly in men and women: average annual percent change (AAPC): 2.0% (95% CI, 1.3-2.6; P < 0.005). Secondary PEs were more common in men (37.8% vs. 32.9%, P < 0.001). Men showed greater comorbidity than women (Charlson index 2.22 ± 0.01 vs. 1.74 ± 0.01, P < 0.001), particularly cancer in the secondary diagnosis group (40.9% vs. 31.6%, P < 0.001). CFRs for PE as main diagnosis were comparable and decreased in parallel in men (from 13.8% in 2003 to 7.3% in 2019) and women (from 13.1% in 2003 to 6.9% in 2019). However, for PE as secondary diagnosis, CFRs remained higher (P < 0.001) in men (from 42.5% in 2003 to 26.2% in 2019) than women (from 34.4% in 2003 to 22.8% in 2019). CONCLUSION: PE hospital diagnosis increased significantly between 2003 and 2019 in men and women for both main and secondary diagnosis. Although in-hospital CFR decreased one third still remains very high, especially in men with secondary PE diagnosis.

General Surgery: Requirements, Rationale, and Robust Results.

Safe, timely, and affordable surgical care is desirable worldwide, but is largely an unmet need. Surgical care is recognized as an important component of public health. Vision for sustainable surgical development is desirable, and general surgeons can contribute substantially toward this mission. In the absence of surgical care, case-fatality rates are high for common and easily treatable conditions. These include congenital anomalies, hernia, fractures, appendicitis, etc. Solution is surgical care. Results of surgery on time are rewarding. General surgeons, as per the Medical Council of India, are required to (1) recognize the health needs of the community and carry out professional obligations, (2) be competent, and (3) be aware of the contemporary advances and developments in the discipline concerned. All this ensures that the general surgeon should be able to treat almost all surgical conditions effectively. With timely, cautious, careful, and tactful surgeries, general surgeons should be able to deliver robust results both electively and in emergency. All this in the true spirit of "Vayam Sevaamahe - We are for service" the motto of the Association of Surgeons of India. General surgeons should boost the best what was termed " Professional patriotism " in the historic Flexner report.

Global COVID-19 case fatality rates influenced by inequalities in human development and vaccination rates.

Aim: COVID-19 has exerted distress on virtually every aspect of human life with disproportionate mortality burdens on older individuals and those with underlying medical conditions. Variations in COVID-19 incidence and case fatality rates (CFRs) across countries have incited a growing research interest regarding the effect of social factors on COVID-19 case-loads and fatality rates. We investigated the effect of population median age, inequalities in human development, healthcare capacity, and pandemic mitigation indicators on country-specific COVID-19 CFRs across countries and regions. Subject and methods: Using population secondary data from multiple sources, we conducted a cross-sectional study and used regional analysis to compare regional differences in COVID-19 CFRs as influenced by the selected indicators. Results: The analysis revealed wide variations in COVID-19 CFRs and the selected indicators across countries and regions. Mean CFR was highest for South America at 1.973% (± 0.742) and lowest for Oceania at 0.264% (± 0.107), while the Africa sub-region recorded the lowest scores for pandemic preparedness, vaccination rate, and other indicators. Population Median Age [0.073 (0.033 0.113)], Vaccination Rate [-3.3389 (-5.570.033 -1.208)], and Inequality-Adjusted Human Development Index (IHDI) [-0.014 (-0.023 -0.004)] emerged as statistically significant predictors of COVID-19 CFR, with directions indicating increasing Population Median Age, higher inequalities in human development and low vaccination rate are predictive of higher fatalities from COVID-19. Conclusion: Regional differences in COVID-19 CFR may be influenced by underlying differences in sociodemographic and pandemic mitigation indicators. Populations with wide social inequalities, increased population Median Age and low vaccination rates are more likely to suffer higher fatalities from COVID-19.

The Influence of SARS-CoV-2 Variants on National Case-Fatality Rates: Correlation and Validation Study.

Background: In 2021, new variants of the SARS-CoV-2 virus appeared with increased transmissibility and virulence as compared with the original wild variant. The first variants of concern (VoCs), Alpha (B1.1.7) and Gamma (P.1), first appeared in the United Kingdom and Brazil, respectively. The Delta (B.1.617.2) variant, seen in India in October 2020, dominated COVID-19 infections across all regions through the second half of 2021. Objective: This research explores the degree to which SARS-CoV-2 VoCs generate waves of fluctuations in case-fatality rates (CFRs) across countries in several regions, increase the risk of mortality to persons with certain comorbidities, and decrease the risk of mortality as the percentage of fully vaccinated populations increases. Methods: This analysis introduces a measure of the temporal dynamics of COVID-19 infections in the form of a proxy CFR (pCFR), which can be compared among countries. It uses economic and demographic data reported by the World Bank and International Monetary Fund, plus publicly available epidemiological and medical statistics reported to the relevant national and international public health authorities. From these ecological data, pandemic average and daily COVID-19 CFRs and their correlations with potential cofactors were computed for 2021, a year dominated by the spread of World Health Organization-designated VoCs. The study does not investigate disease pathology; rather, it compares the daily case rates and pCFRs to reveal underlying contributing factors that vary from country to country and region to region. Results: The in-depth global regression analysis of cofactors found that the strongest single correlation with COVID-19 fatality was 0.36 (SD 0.02) with P<.001 for chronic kidney disease. No other single physiological cofactors display positive correlations exceeding 0.26 (SD 0.26), with P=.008 (asthma) and P=.01 (coronary disease). The study confirms that the pCFR is a valuable metric for tracking waves of infection due to different VoCs within countries. Conclusions: The influence of social, economic, and medical cofactors on the CFR due to VoCs remains qualitatively similar, albeit strengthened, to the levels found for the wild strain. The strong regional variations of the influence of all cofactors observed for the wild strain persists in infections for all VoCs with very strong correlation coefficients seen in the Middle East for asthma (0.76), coronary heart disease (0.60), lung disease (0.70), and chronic kidney disease (0.52). Strong regional variations emphasize the influence on COVID-19 mortality due to regional differences in national economics, patterns of health care policies, and variations in cultural practices and environment. The pCFR-based analysis reveals clear patterns of the spread of VoCs across regions, but there is little evidence for the spread of the Lambda and Mu (B.1.621) variants of interest outside of South America.

Time trends in the epidemiology of nonrheumatic aortic valve disease in Spain, 2003-2018.

INTRODUCTION AND OBJECTIVES: The impact of therapeutic improvements in nonrheumatic aortic valve disease (NRAVD) has been assessed at the patient level but not in the whole population with the disease. Our objective was to assess temporal trends in hospitalization rates, treatment and fatality rates in patients with a main or secondary NRAVD diagnosis. METHODS: Retrospective analysis of administrative claims from patients hospitalized with a main or secondary NRAVD diagnosis between 2003 and 2018 in Spain. Time trends in age- and sex-standardized hospitalization and procedure rates, baseline characteristics and case fatality rates by diagnosis type were assessed by Poisson regression and joinpoint analysis. RESULTS: Hospital admissions in patients with NRAVD increased from 69 213 in 2003 to 136 185 in 2018. The crude in-hospital fatality rate increased from 6.7% to 8.7% (IRR, 1.015; 95%CI, 1.012-1.018; P <.001) without changes after adjustment. Adjusted fatality rates decreased in patients with a main NRAVD diagnosis (5.5% to 3.5%; IRR, 0.953; 95%CI, 0.942-0.964) but increased in those with a secondary diagnosis (8.0% to 8.8%; IRR, 1.005; 95%CI, 1.002-1.009). Aortic valve replacements increased from 10.5 to 17.1 procedures per 100 000 population (IRR, 1.033; 95%CI, 1.030-1.037), mainly driven by transcatheter procedures (IRR, 1.345; 95%CI, 1.302-1.389). CONCLUSIONS: Hospitalizations in patients with NRAVD are increasing, with most being secondary diagnoses. The use of aortic valve replacement is increasing with a reduction in fatality rates but only in patients with a main diagnosis.

Epidemiological and sociodemographic transitions of female breast cancer incidence, death, case fatality and DALYs in 21 world regions and globally, from 1990 to 2017: An Age-Period-Cohort Analysis.

Introduction: Breast cancer (BC) is the most widely studied disease due to its higher prevalence, heterogeneity and mortality. Objectives: This study aimed to compare female BC trends among 21 world regions and globally over 28 year of data and to assess the association between sociodemographic transitions and female BC risks. Methods: We used Global burden of disease study data and measure the female BC burden according to 21 world regions and sociodemographic indices (SDI). Age-period-cohort (APC) analysis was used to estimate time and cohort trend of BC in different SDI regions. Results: By world regions, age-standardised rate of female BC incidence were high in high-income-North America (ASR, 92.9; (95 %UI, 89.2, 96.6)), Western Europe (84.7; (73.4, 97.2)) and Australia (86; (81.7, 90.2)) in 2017. Whereas this rate was significantly increased by 89.5% between 1990 and 2017 in East Asia. We observed negative association between SDI and death, and DALYs in 25th and below percentiles of death and DALYs for the worldwide regions. Further, there was observed a strong negative correlation between SDI and case fatality percent (r2017 = -0.93; r1990 = -0.92) in both 2017 and 1990 worldwide and highest case fatality percentage was observed in Central Sub-Saharan Africa. Overall, the risk of case-fatality rate tends to decrease most noticeably in high middle SDI countries, and the reduction of the risk of case-fatality rate in the recent cohort was the lowest in the low SDI countries. Conclusions: Remarkable variations exist among various regions in BC burden. There is a need to reduce the health burden from BC in less developed and under developing countries, because under-developed countries are facing higher degree of health-related burden. Public health managers should execute more classified and cost-effective screening and treatment interferences to lessen the deaths caused by BC, predominantly among middle and low SDI countries having inadequate healthcare supplies.

Effects of the enhanced public health intervention during the COVID-19 epidemic on respiratory and gastrointestinal infectious diseases in China.

The public health interventions to mitigate coronavirus disease 2019 (COVID-19) could also potentially reduce the global activity of influenza. However, this strategy's impact on other common infectious diseases is unknown. We collected data of 10 respiratory infectious (RI) diseases, influenza-like illnesses (ILIs), and seven gastrointestinal infectious (GI) diseases during 2015-2020 in China and applied two proportional tests to check the differences in the yearly incidence and mortality, and case-fatality rates (CFRs) over the years 2015-2020. The results showed that the overall RI activity decreased by 7.47%, from 181.64 in 2015-2019 to 168.08 per 100 000 in 2020 (p < 0.001); however, the incidence of influenza was seen to have a 16.08% escalation (p < 0.001). In contrast, the average weekly ILI percentage and positive influenza virus rate decreased by 6.25% and 61.94%, respectively, in 2020 compared to the previous 5 years (all p < 0.001). The overall incidence of GI decreased by 45.28%, from 253.73 in 2015-2019 to 138.84 in 2020 per 100 000 (p < 0.001), and with the greatest decline seen in hand, foot, and mouth disease (HFMD) (64.66%; p < 0.001). The mortality and CFRs from RI increased by 128.49% and 146.95%, respectively, in 2020, compared to 2015-2019 (p < 0.001). However, the mortality rates and CFRs of seven GI decreased by 70.56% and 46.12%, respectively (p < 0.001). In conclusion, China's COVID-19 elimination/containment strategy is very effective in reducing the incidence rates of RI and GI, and ILI activity, as well as the mortality and CFRs of GI diseases.

Examining the Relationship Between Hospital-Community Partnerships and COVID-19 Case-Fatality Rates.

Abtract During the COVID-19 pandemic, hospitals across the United States were tasked to develop partnerships with other hospitals and community organizations to overcome the unexpected challenges. The aim of this study is to examine COVID-19 case-fatality rates and explore their relationship with hospital-community partnerships. This study employed a cross-sectional design using a multilevel generalized linear model with a Poisson regression distribution and publicly available COVID-19 mortality data from February to October 2020 across 2526 hospital service areas (HSAs). HSAs with a greater number of partnerships were found to have a reduced risk of higher case-fatality rates than those with fewer health system partnerships. The findings indicated the need for greater cooperation between individual health care systems, state and local governments, and community programs for better outcomes in the ongoing and evolving COVID-19 pandemic, and to be better prepared for future pandemics or large-scale public health crises. This study provides the necessary insights for policy makers, hospital administrators, and public health leaders to understand the critical importance of community partnerships and their influence on reducing the COVID-19 case-fatality rate, as well as their potential effects on improving the health of vulnerable populations as a means to achieve the Centers for Disease Control and Prevention's goal of achieving health equity. This research illustrates the need for further inquiries into the importance of these health care partnerships for positive health care outcomes.

The contribution of method choice to gender disparity in suicide mortality: A population-based study in Hong Kong and the United States of America.

BACKGROUND: In most countries, more females than males attempt suicide, yet suicide mortality is typically higher for males. The aim of this study was to investigate how suicide method choice contributed to gender disparity in suicide mortality. METHODS: This study used population-based data collected in Hong Kong (HK) and the United States of America (USA) (2007-2014), comprising suicide deaths and medically treated suicide attempts. We calculated suicide rates, suicide act rates, and case fatality rates (CFRs), by gender and suicide method in HK and the USA respectively. Decomposition analysis was used to quantify the contribution of gender differences in method choice and method-specific CFRs to the excess male suicide rates in each region. RESULTS: Gender disparity in suicide mortality was mostly driven by gender differences in method used in suicide acts. In HK, gender difference in choosing jumping as the method in suicide acts explained 44.5% of the gender imbalance in suicide rates, whilst in USA, 62.4% of male excess in suicide rates was explained by gender difference in using firearms in suicide acts. LIMITATIONS: Cases of suicide attempts in this study were restricted to those severe enough to require medical attention. CONCLUSION: Gender-specific suicide method choice largely determined gender patterns in suicide. Our findings highlighted the importance of developing locally tailored suicide prevention strategies targeting commonly used and highly lethal suicide methods. Future research is needed to explore underlying reasons for gender differences in method choice.

Global Temporal Patterns of Age Group and Sex Distributions of COVID-19.

Since the beginning of 2020, COVID-19 has been the biggest public health crisis in the world. To help develop appropriate public health measures and deploy corresponding resources, many governments have been actively tracking COVID-19 in real time within their jurisdictions. However, one of the key unresolved issues is whether COVID-19 was distributed differently among different age groups and between the two sexes in the ongoing pandemic. The objectives of this study were to use publicly available data to investigate the relative distributions of COVID-19 cases, hospitalizations, and deaths among age groups and between the sexes throughout 2020; and to analyze temporal changes in the relative frequencies of COVID-19 for each age group and each sex. Fifteen countries reported age group and/or sex data of patients with COVID-19. Our analyses revealed that different age groups and sexes were distributed differently in COVID-19 cases, hospitalizations, and deaths. However, there were differences among countries in both their age group and sex distributions. Though there was no consistent temporal change across all countries for any age group or either sex in COVID-19 cases, hospitalizations, and deaths, several countries showed statistically significant patterns. We discuss the potential mechanisms for these observations, the limitations of this study, and the implications of our results on the management of this ongoing pandemic.

COVID-19: facts, figures, estimated relationships and analysis.

This study attempts an integrated analysis of the health and economic aspects of COVID-19 that is based on publicly available data from a wide range of data sources. The analysis is done keeping in mind the close interaction between the health and economic shocks of COVID-19. The study combines descriptive and qualitative approaches using figures and graphs with quantitative methods that estimate the plotted relationships and econometric estimation that attempts to explain cross-country variation in COVID-19 incidence, deaths and 'case fatality rates'. The study seeks to answer a set of questions on COVID-19 such as: what are the economic effects of COVID-19, focussing on international inequality and global poverty? How effective was lockdown in curbing COVID-19? What was the effect of lockdown on economic growth? Did the stimulus packages work in delinking the health shocks from the economic ones? Did 'better governed countries' with greater public trust and those with superior health care fare better than others? Did countries that have experienced previous outbreaks such as SARS fare better than those who have not? The study provides mixed messages on the effectiveness of lockdowns in controlling COVID-19. While several countries, especially in the East Asia and Pacific region, have used it quite effectively recording low infection rates going into lockdown and staying low after the lockdown, the two spectacular failures are Brazil and India. In contrast to lockdown, the evidence on the effectiveness of stimulus programs in avoiding recession and promoting growth is unequivocal. The effectiveness is much greater in the case of emerging/developing economies than in the advanced economies. Multilateral institutions such as the World Bank and the IMF need to work out a coordinated strategy to declare immediate debt relief and provide additional liquidity to the poorer economies to help them announce effective stimulus measures. COVID-19 will lead to a large increase in the global pool of those living in 'extreme poverty'. A poignant feature of our results is that while a significant share of health shocks from COVID-19 is borne by the advanced economies, the burden of 'COVID-19 poverty' will almost exclusively fall on two of the poorest regions, namely, Sub-Saharan Africa and South Asia.

High health expenditures and low exposure of population to air pollution as critical factors that can reduce fatality rate in COVID-19 pandemic crisis: a global analysis.

One of the problems hardly clarified in Coronavirus Disease 2019 (COVID-19) pandemic crisis is to identify factors associated with a lower mortality of COVID-19 between countries to design strategies to cope with future pandemics in society. The study here confronts this problem by developing a global analysis based on more than 160 countries. This paper proposes that Gross Domestic Product (GDP) per capita, healthcare spending and air pollution of nations are critical factors associated with fatality rate of COVID-19. The statistical evidence seems in general to support that countries with a low average COVID-19 fatality rate have high expenditures in health sector >7.5% of GDP, high health expenditures per capita >$2,300 and a lower exposure of population to days exceeding safe levels of particulate matter (PM2.5). Another relevant finding here is that these countries have lower case fatality rates (CFRs) of COVID-19, regardless a higher percentage of population aged more than 65 years. Overall, then, this study finds that an effective and proactive strategy to reduce the negative impact of future pandemics, driven by novel viral agents, has to be based on a planning of enhancement of healthcare sector and of environmental sustainability that can reduce fatality rate of infectious diseases in society.

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

The crude case fatality rate (CFR), because of the calculation method, is the most accurate when the pandemic is over since there is a possibility of the delay between disease onset and outcomes. Adjusted crude CFR measures can better explain the pandemic situation by improving the CFR estimation. However, no study has thoroughly investigated the COVID-19 adjusted CFR of the South Asian Association For Regional Cooperation (SAARC) countries. This study estimated both survival interval and underreporting adjusted CFR of COVID-19 for these countries. Moreover, we assessed the crude CFR between genders and across age groups and observed the CFR changes due to the imposition of fees on COVID-19 tests in Bangladesh. Using the daily records up to October 9, we implemented a statistical method to remove the delay between disease onset and outcome bias, and due to asymptomatic or mild symptomatic cases, reporting rates lower than 50% (95% CI: 10%-50%) bias in crude CFR. We found that Afghanistan had the highest CFR, followed by Pakistan, India, Bangladesh, Nepal, Maldives, and Sri Lanka. Our estimated crude CFR varied from 3.708% to 0.290%, survival interval adjusted CFR varied from 3.767% to 0.296% and further underreporting adjusted CFR varied from 1.096% to 0.083%. Furthermore, the crude CFRs for men were significantly higher than that of women in Afghanistan (4.034% vs. 2.992%) and Bangladesh (1.739% vs. 1.337%) whereas the opposite was observed in Maldives (0.284% vs. 0.390%), Nepal (0.006% vs. 0.007%), and Pakistan (2.057% vs. 2.080%). Besides, older age groups had higher risks of death. Moreover, crude CFR increased from 1.261% to 1.572% after imposing the COVID-19 test fees in Bangladesh. Therefore, the authorities of countries with higher CFR should be looking for strategic counsel from the countries with lower CFR to equip themselves with the necessary knowledge to combat the pandemic. Moreover, caution is needed to report the CFR.

Pathogenicity and Virulence of Ebolaviruses with Species- and Variant-specificity.

Ebola virus (EBOV), belonging to the species Zaire ebolavirus in the genus Ebolavirus, causes a severe febrile illness in humans with case fatality rates (CFRs) up to 90%. While there have been six virus species classified, which each have a single type virus in the genus Ebolavirus, CFRs of ebolavirus infections vary among viruses belonging to each distinct species. In this review, we aim to define the ebolavirus species-specific virulence on the basis of currently available laboratory and experimental findings. In addition, this review will also cover the variant-specific virulence of EBOV by referring to the unique biological and pathogenic characteristics of EBOV variant Makona, a new EBOV variant isolated from the 2013-2016 EBOV disease outbreak in West Africa. A better definition of species-specific and variant-specific virulence of ebolaviruses will facilitate our comprehensive knowledge on genus Ebolavirus biology, leading to the development of therapeutics against well-focused pathogenic mechanisms of each Ebola disease.