Why do COVID-19 Death Rates Vary from Country to Country?

Countries around the world have vastly different COVID-19 mortality rates. At the start of the outbreak, when the coronavirus felt like a far-away problem, China’s mortality rate appeared to be relatively low. In fact, an early-circulated myth was that the death rate was similar to that of the seasonal flu (1%). This perhaps gave the rest of the world a false sense of security.

While Asia acted fast, the West was seemingly less prepared. Statistics show that European countries now have the highest death rate, with Belgium leading the way with a rate of 16.3%. Sweden, Spain, France, Italy, the Netherlands, and the UK closely follow with mortality rates between 12 and 15%. 

This is a stark difference from Asian countries, which interestingly have the lowest COVID-19 death rates. Vietnam, Hong Kong, and Singapore currently have morality rates under 1%, and China, where the virus originated, sits at 5.6%. 

Despite the US having the highest number of cases, currently nearing two million, the death rate stands at just 6%.

There are a variety of socio-economic factors at play that could help explain the drastically different death rates from country to country. Let’s take a look at some of the possible explanations. But first, it’s important to note that as this a new virus, research into the way it works is still ongoing. 

Testing Capacity 

It’s easy to assume that widespread testing would lead to worse-looking statistics, and vise-versa, as more testing could mean a higher number of reported cases and deaths. However, that doesn’t appear to be the case. 

Although it’s true that a lack of testing may lead to under-reported COVID-19 related deaths, statics show that the countries with better access to testing have lower mortality rates. It appears that countries that rolled out ample testing had better control over the spread of the virus.

For example, testing was widespread in Asia from the beginning of the outbreak as well as in Germany, which has Europe’s lowest death rate. However, in the UK and US testing was much less readily available, even for front-line health workers. 

Case Definitions 

The way we define COVID-19 has changed over the course of the pandemic. From mid-April, the US Centres for Disease Control and Prevention (CDC) released guidelines for doctors to use their judgment to include probable cases when counting the number of infected people. 

Previously, in China, six exact criteria needed to be met before counting a confirmed case. This suggests that China’s confirmed cases and deaths may have been greatly underestimated. 

Another reason for varying death rates could be the difference in criteria for reporting COVID-19 deaths around the world, especially when other health conditions and chronic illnesses are involved at the same time. 

Response Rate

One of the main reasons why Asia has a lower mortality rate has to be due to the speed in which a large portion of the continent reacted to the outbreak with ready-to-go strategies. The 2003 SARS epidemic is a very recent and painful memory for many Asian countries, which could explain why they had the tools and know-how to act fast and keep the death rate low.

Vietnam, a country that borders China, has 0 reported COVID-19 deaths and around 300 confirmed cases. Strict lockdown measures, social distancing guidelines, and border closures were put into place before there was even any chance for a large nation-wide outbreak to take place. Wearing a mask is also commonplace in many Asian countries, including Vietnam.

While most of Asia went into early lockdown and rolled out stringent containment plans, many European countries and the US continued to allow in flights from foreign countries and entered into a state of lockdown when it was arguably too late to control the spread. 

Demographics 

Data shows that COVID-19 is much more fatal for older generations, which may explain why countries with older populations tend to have higher mortality rates. Italy has one of the world’s oldest populations, with an average age of 46.5, and subsequently one of the highest COVID-19 death rates. 

In comparison, 60% of Hong Kong’s COVID-19 cases were from incoming travelers, which were mostly made up of returning students. Cases in relatively healthy young people can be seen to help lower the overall mortality rate. 

Chad Wells, a research associate with Yale University’s Center for Infectious Disease Modeling and Analysis, said that the extent to which older people have close contact with younger generations is a possible risk factor for infection. Italian culture is very family-orientated, which may explain the high numbers of infection. 

Lifestyle and Culture

Other cultural factors may be at play. There is much less evidence to support these possibilities, but perhaps the explosion of cases in Italy and New York is down to the more intimate, southern European form of greeting one another. 

An unhealthy lifestyle, including excessive drinking and smoking, could also explain the higher mortality rates in generally unhealthier countries. At large, European and US citizens and more likely to drink and smoke than people in Asia. This lowers the effectiveness of the immune system and in turn, leads to a greater risk of infection and less ability to fight the virus. 

It's also much less common to wear masks in the west, despite many studies suggesting that infection rates would reduce if more Americans wore masks.


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