Original Research Article

Global, regional, and national incidence and mortality of COVID-19 in 237 countries and territories, January 2022: a systematic analysis for World Health Organization COVID-19 Dashboard

So Young Kim1,*https://orcid.org/0000-0002-7361-4930, Abdullah Özgür Yeniova2,*https://orcid.org/0000-0003-1681-364X
Author Information & Copyright
1Department of Otorhinolaryngology-Head & Neck Surgery, CHA University, Pocheon, Republic of Korea
2Division of Gastroenterology, Department of Internal Medicine, Tokat Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey
*Correspondence: So Young Kim, E-mail: sossi81@hanmail.net
*Correspondence: Abdullah Özgür Yeniova, E-mail: ozgur.yeniova@gop.edu.tr

© Copyright 2022 Life Cycle. This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: Mar 12, 2022; Revised: Apr 25, 2022; Accepted: May 01, 2022

Published Online: May 12, 2022

Abstract

Objective:

To estimate global, regional, and national incidences and mortality of the coronavirus disease 2019 (COVID-19) in 237 countries and territories since the outbreak of the COVID-19 pandemic to 31 January, 2022.

Methods:

Comprehensive estimates were produced through global, regional, and national studies of cumulative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections for the duration of the COVID-19 pandemic. The incidence and mortality rate of COVID-19 was analyzed based on the World Health Organization (WHO) COVID-19 Dashboard data since the outbreak of the COVID-19 pandemic to 31 January, 2022. The number of cumulative total confirmed cases, the number of cumulative total confirmed cases (cumulative incidence) per 100,000, the number of cumulative total death cases, and the number of cumulative total death cases (cumulative death rate) per 100,000 population were calculated according to the WHO regions, World Bank income groups, and each country.

Results:

A total of 349,641,119 of confirmed COVID-19 cases were reported globally on 31 January, 2022 (cumulative incidence of COVID-19, 4,485.72 per 100,000 population). Europe demonstrated the highest cumulative incidence of COVID-19 (14,039.95 per 100,000 population), followed by the Americas (12,512.57 per 100,000 population) showing a cumulative total death cases and cumulative death rate of COVID-19 of 5,592,266 and 71.75 per 100,000 population, respectively. The Americas presented highest cumulative death rate of COVID-19 (14,039.95 per 100,000 population), followed by Europe (12,512.57 per 100,000 population). The nation with the highest cumulative total cases of COVID-19 was the United States of America (n=69,727,991). However, the cumulative death rate of the COVID-19 was found higher in developing and underdeveloped countries.

Conclusion:

From the start of the COVID-19 pandemic to 31 January, 2022, 349.6 million of the worldwide population suffered symptoms of SARS-COV-2 and 5.6 million lost their lives due to it. The population in Europe and other high-income groups showed high incidence rates of COVID-19 while the death rate was high in Americas and other upper middle-income nations. According to figures of nationalities, the countries with compromised economic status presented a higher death rate despite relatively lower incidence of COVID-19 than the developed countries. The results of this study may provide crucially important for COVID-19 research and proper public health policies and strategies.

Keywords: COVID-19; SARS-CoV-2; incidence; death

1. Introduction

The coronavirus disease 2019 (COVID-19) pandemic era has lasted for more than 2 years since first case was reported in December 2019.[1] Viral factors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and host defense strategies have been developed during the COVID-19 pandemic.[2] In order to sustain and spread infections, the virus constantly developed novel variants.[3] Such variants have been reported as the alpha, beta, delta, and omicron SARS-CoV-2.[4, 5] By the end of December 2021, the omicron variant consisted of about 95% of the total COVID-19 confirmed cases.[6] Compared to the delta variant, the omicron variant presented a higher breakthrough of infections in the vaccinated population, while showing a milder clinical severity with less admission (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.21- 0.52), less intensive care admission (OR, 0.38; 95% CI, 0.17 to 0.87), and less mortality rate (OR, 0.26; 95% CI, 0.06-1.02).[6]

Efforts to suppress the COVID-19 infection and mortality have been introduced including quarantine and vaccinations.[7] Governments and public strategies have executed quarantine measures, such as selective or transient lockdown periods, social distancing, enforcing wearing of facial masks, and other preventive measures.[8, 9] A various types of vaccines against the SARS-CoV-2 have been developed to prevent transmission of SARS-CoV-2 and clinically serious disease [10] Moreover, pharmaceutical therapeutics against COVID-19 became available, although with limited efficiency in eradicating or ending the pandemic.[11] All of these host and viral factors can be seen to have influence on the epidemiology of the COVID-19.

The number of cases and severity of COVID-19 have been dynamically changing which made it challenging to be estimated. In this study, we aimed to give a long term global trend of incidences and mortality of SARS CoV-2 infection by presenting the total number of cases and mortality rate according to geographic region, ethnicity, and economic status. Many previous researches on the prevalence and mortality of COVID-19 have focused on Europe or America, which were estimated to account for about 78 % of the evidence.[12] Although there are inconsistencies in the data, the global infection fatality rate was estimated about 0.15% in 1.5 to 2.0 billion of COVID-19 cases in February 2022.[12]

This study investigated the incidence and death rate of COVID-19 based on data from the World Health Organization (WHO) from the start of the COVID-19 pandemic up to 31 January, 2022. The epidemiology of COVID-19 was analyzed according to regions, income levels, and nationalities. This epidemiologic updates on COVID-19 aims to give an insight into the ways to the endemic phase of COVID-19.

2. Methods

Global, regional and national estimates of cumulative SARS-CoV-2 infection during COVID-19 pandemic was analyzed The cumulative incidence and mortality rate of COVID-19 were calculated based on the WHO COVID-19 Dashboard data from the start of the COVID-19 pandemic to 31 January, 2022, which referred to WHO’s officially reported numbers of SARS-CoV-2 infection cases and related deaths under the International Health Regulation.

Cases primarily defined as laboratory-confirmed SARS-CoV-2 cases or deaths based on WHO’s guideline are those as the followings; [13] 1) a patient with a positive nucleic acid amplification test; 2) a patient with a positive SARS-CoV-2 antigen rapid diagnostic test and meeting either the probable case definition; or 3) an asymptomatic patient with positive SARS-CoV-2 antigen rapid diagnostic test who had contact of a probable or confirmed case. Underestimations or overestimations of truce cases and mortality may exist due to local adaptations such as testing strategies, reporting practice, lag times, and case detection methods. Such factors may have influence on collecting the accurate numbers and can possibly delay issue of global data.

2.1 Statistical Analysis

All efforts from governments, international, national, and regional authorities have been made to ensure the reliability and accuracy of the dataset and significant data errors been detected by the WHO, which may be revised at more frequent intervals. The number of cumulative total confirmed cases, the number of cumulative total confirmed cases (cumulative incidence) per 100,000, the number of cumulative total death cases, and the number of cumulative total death cases (cumulative death rate) per 100,000 population were collected from WHO data and analyzed according to the regions classified by the WHO (Europe, Americas, South-East Asia, Eastern Mediterranean, Western Pacific, and Africa), income groups (high-income, upper middle-income, lower middle-income, and lower income), and each country (total of 237 countries). We systematically reviewed input registration data and all figures were generated using R software version 3.1.1 (R Foundation, Vienna, Austria).

2.2 Patient and Public Involvement

No patients were directly involved in designing the research question or conducting the research. No patients were asked to interpret or write up the results. There are no plans to involve patients or relevant patient communities in dissemination at this moment.

3. Results

A total of 349,641,119 of cases were confirmed COVID-19 globally on 31 January, 2022 (Table 1 and Fig. 1). The cumulative incidence of COVID-19 was 4,485.72 people per 100,000 of the population. Among the six WHO regions, Europe demonstrated the highest cumulative incidence of COVID-19 followed by Americas (14,039.95 and 12,512.57 per 100,000 population, respectively). Cumulative total death cases related to COVID-19 is calculated as 5,592,266 (Fig. 2). The cumulative death rate of COVID-19 was 71.75 per 100,000 population and (Fig. 2 to 4). The Americas presented the highest cumulative death rate of COVID-19, followed by Europe (241.63 and 186.75 per 100,000 population, respectively).

Table 1. Cumulative total cases and total deaths of COVID-19 by WHO regions and World Bank income groups
Name Cumulative total confirmed cases (number) Cumulative incidence, per 100,000 population (number) Cumulative total death cases (number) Cumulative death rate, per 100,000 population (number)
Global 349,641,119 4,485.72 5,592,266 71.75
By WHO Region Europe 131,002,165 14,039.95 1,742,509 186.75
Americas 127,975,395 12,512.57 2,471,381 241.63
South-East Asia 50,112,782 2,479.13 731,020 36.16
Eastern Mediterranean 18,299,374 2,503.94 319,704 43.75
Western Pacific 14,308,546 728.33 165,066 8.40
Africa 7,942,093 707.89 162,576 14.49
By World Bank income group
High-income 181,054,222 42,742.51 2,086,351 419.10
Upper middle-income 104,060,725 33,935.34 2,513,818 619.14
Lower middle-income 62,028,291 13,066.81 945,047 260.83
Lower income 1,784,154 98.32 40,729 18.99
Download Excel Table
lc-2-0-10-g1
Fig. 1. Global cumulative total cases of SARS-CoV-2 infections, since the outbreak of the COVID-19 pandemic to 31 January, 2022.
Download Original Figure
lc-2-0-10-g2
Fig. 2. Global cumulative total deaths cases of SARS-CoV-2 infections, since the outbreak of the COVID-19 pandemic to 31 January, 2022.
Download Original Figure

When focusing on income levels, groups with the highest income demonstrated the highest cumulative incidence of confirmed COVID-19, followed by the upper middle-income group (42,742.51 and 33,935.34 per 100,000 population, respectively). The cumulative death rate of COVID-19 was highest in the upper middle-income group, followed by the high-income group (619.14 and 419.10 per 100,000 population, respectively).

The nation with the highest cumulative total cases of COVID-19 was the United States of America (n=69,727,991) (Table 2). However, the cumulative incidence of COVID-19 in the USA was 21,065.69 per 100,000 population and countries such as Andorra, Seychelles and Gibraltar showed higher cumulative incidence than USA and higher in other countries such as Andorra, Seychelles, and Gibraltar. The total cumulative deaths of COVID-19 was highest in United States of America (n=858,470) but the cumulative death rate of COVID-19 was highest in Peru (619.137 per 100,000 population). Republic of Korea indicated a relatively low incidence and death rate of COVID-19, demonstrating 1446.118 per 100,000 population of the cumulative incidence of COVID-19 and 12.805 per 100,000 population of the cumulative death rate of COVID-19.

Table 2. Cumulative total cases and total deaths of COVID-19 according to each countries
Name Cumulative total confirmed cases (number) Cumulative incidence, per 100,000 population (number) Cumulative total death cases (number) Cumulative death rate, per 100,000 population (number)
Global 349,641,119 4,485.72 5,592,266 71.75
United States of America 69,727,991 21,065.69 858,470 259.35
India 39,543,328 2,865.45 489,848 35.50
Brazil 23,909,175 11,248.23 622,801 293.00
France 16,286,388 25,040.82 125,921 193.61
The United Kingdom 15,859,292 23,361.65 153,862 226.65
Russian Federation 11,108,191 7,611.77 326,767 223.91
Turkey 10,946,238 12,978.85 85,969 101.93
Italy 9,923,678 16,638.88 143,523 240.64
Spain 8,834,364 18,664.43 91,599 193.52
Germany 8,744,840 10,514.83 116,746 140.38
Argentina 7,792,652 17,241.99 119,103 263.53
Iran (Islamic Republic of) 6,250,490 7,441.68 132,230 157.43
Colombia 5,714,092 11,229.89 132,023 259.46
Mexico 4,646,957 3,604.17 303,085 235.07
Poland 4,547,315 11,979.82 103,846 273.58
Indonesia 4,289,305 1,568.17 144,227 52.73
Netherlands 3,889,669 22,344.68 21,211 121.85
Ukraine 3,870,370 8,849.85 99,282 227.02
South Africa 3,581,359 6,038.51 94,177 158.79
Philippines 3,417,216 3,118.44 53,472 48.80
Peru 2,894,215 8,777.84 204,141 619.14
Canada 2,868,862 7,601.21 32,220 85.37
Malaysia 2,832,945 8,752.84 31,892 98.54
Czechia 2,763,800 25,844.55 37,050 346.46
Belgium 2,697,239 23,408.58 28,780 249.77
Israel 2,385,826 27,564.15 8,454 97.67
Thailand 2,384,639 34,16.39 22,045 31.58
Portugal 2,221,825 21,579.69 19,569 190.07
Japan 2,169,653 1,715.46 18,506 14.63
Iraq 2,154,237 5,355.80 24,287 60.38
Viet Nam 2,141,422 2,199.97 36,719 37.72
Romania 2,017,129 10,435.85 59,547 308.07
Chile 1,965,393 10,281.30 39,512 206.69
Switzerland 1,871,445 21,623.66 12,164 140.55
Greece 1,793,311 16,730.89 22,635 211.18
Sweden 1,784,005 17,274.17 15,674 151.77
Bangladesh 1,699,964 1,032.22 28,238 17.15
Australia 1,657,485 6,499.97 3,103 12.17
Austria 1,609,872 18,086.29 13,519 151.88
Serbia 1,544,900 22,303.53 13,271 191.59
Hungary 1,441,385 14,753.89 40,944 419.10
Denmark 1,397,833 24,006.35 3,608 61.96
Pakistan 1,367,605 619.13 29,097 13.17
Kazakhstan 1,243,220 6,621.08 18,391 97.95
Ireland 1,145,968 23,083.53 6,087 122.61
Jordan 1,141,048 11,183.31 13,073 128.13
Morocco 1,098,413 2,975.88 15,132 41.00
Georgia 1,059,392 26,556.67 14,732 369.30
Cuba 1,022,112 9,023.98 8,363 73.84
Slovakia 921,422 16,882.44 17,675 323.84
Nepal 918,448 3,152.19 11,659 40.02
Bulgaria 880,228 12,662.45 32,664 469.89
Croatia 877,060 21,612.23 13,407 330.37
Lebanon 865,229 12,676.52 9,487 139.00
Tunisia 853,905 7,225.08 25,988 219.89
United Arab Emirates 825,699 8,348.49 2,214 22.39
Bolivia (Plurinational State of) 804,677 6,893.48 20,570 176.22
Republic of Korea 741,413 1,446.12 6,565 12.81
Belarus 726,860 7,692.19 5,933 62.79
Guatemala 669,012 3,734.25 16,263 90.78
Ecuador 664,664 3,767.28 34,287 194.34
Saudi Arabia 652,354 1,873.83 8,920 25.62
Costa Rica 643,496 12,632.14 7,451 146.27
Panama 637,519 14,775.28 7,583 175.75
Azerbaijan 633,731 6,250.32 8,610 84.92
Norway 622,753 1,1602.12 1,414 26.34
Lithuania 612,500 2,1921.27 7,762 277.80
Slovenia 603,341 2,8787.26 6,250 298.21
Sri Lanka 601,886 2,810.81 15,299 71.45
Uruguay 580,066 16,698.65 6,303 181.45
Dominican Republic 539,580 4,974.05 4,287 39.52
Myanmar 534,071 981.57 19,310 35.49
Paraguay 532,648 7,467.86 16,953 237.69
Kuwait 497,454 11,648.42 2,486 58.21
occupied Palestinian territory, including east Jerusalem 484,979 9,506.76 5,056 99.11
Venezuela (Bolivarian Republic of) 467,864 1,645.33 5,402 19.00
Ethiopia 462,107 401.96 7,244 6.30
Puerto Rico 442,080 15,452.73 3,696 129.19
Mongolia 428,368 13,066.81 2,021 61.65
Finland 426,826 7,724.95 1,815 32.85
Egypt 410,098 400.74 22,368 21.86
Republic of Moldova 409,397 10,148.75 10,522 260.84
Libya 405,425 5,900.27 5,921 86.17
Honduras 387,515 3,912.47 10,469 105.70
Armenia 352,399 11,892.38 8,028 270.92
Latvia 335,541 17,589.00 4,795 251.35
Bosnia and Herzegovina 333,131 10,153.91 14,026 427.52
Bahrain 330,621 19,430.29 1,399 82.22
Qatar 323,345 11,223.15 634 22.01
Oman 322,438 6,314.11 4,128 80.84
Kenya 320,229 595.54 5,554 10.33
Singapore 313,772 5,363.31 848 14.50
Zambia 301,630 1,640.72 3,895 21.19
Estonia 296,466 22,307.85 2,008 151.09
North Macedonia 256,281 1,2301.21 8,218 394.46
Nigeria 252,187 122.34 3,124 1.52
Albania 248,070 8,620.13 3,305 114.85
Botswana 243,946 10,373.50 2,544 108.18
Cyprus 239,073 26,922.48 712 80.18
Algeria 236,670 539.71 6,495 14.81
Zimbabwe 228,254 1,535.73 5,294 35.62
Mozambique 222,596 712.18 2,157 6.90
Uzbekistan 215,063 642.57 1,542 4.61
Montenegro 213,135 33,935.34 2,507 399.16
Kyrgyzstan 195,820 3,001.45 2,851 43.70
Kosovo 181,403 10,102.27 2,988 166.40
Uganda 160,419 350.71 3,479 7.61
Afghanistan 159,682 410.20 7,393 18.99
Ghana 155,496 500.42 1,367 4.40
Namibia 155,027 6,101.25 3,902 153.57
Luxembourg 137,570 21,972.25 943 150.61
China 137,350 9.34 5,700 0.39
Réunion 133,617 14,924.07 462 51.60
Lao People’s Democratic Republic 129,953 1,786.16 526 7.23
Rwanda 128,009 988.32 1,432 11.06
El Salvador 127,012 1,958.19 3,855 59.43
Cambodia 121,026 723.89 3,015 18.03
Jamaica 119,565 4,037.77 2,594 87.60
Maldives 117,461 21,730.15 269 49.77
Cameroon 114,113 429.87 1,867 7.03
Trinidad and Tobago 105,969 7,571.98 3,286 234.80
Angola 96,582 293.86 1,888 5.74
Democratic Republic of the Congo 84,519 94.37 1,278 1.43
Senegal 84,295 503.44 1,925 11.50
Malawi 83,823 438.18 2,523 13.19
Côte d’Ivoire 80,176 303.95 779 2.95
Martinique 77,075 20,538.82 821 218.78
Guadeloupe 73,660 18,409.29 835 208.69
French Guiana 72,819 24,380.11 359 120.20
Mauritius 70,218 5,521.29 786 61.80
Suriname 69,741 11,888.37 1,237 210.87
Eswatini 68,081 5,868.22 1,369 118.00
Malta 65,866 12,800.35 532 103.39
Fiji 60,931 6,796.96 768 85.67
Iceland 58,409 16,040.52 44 12.08
Mauritania 57,384 1,234.16 927 19.94
Madagascar 57,375 207.20 1,223 4.42
Guyana 56,585 7,194.06 1,130 143.67
Cabo Verde 55,306 9,947.36 389 69.97
Sudan 55,149 125.77 3,404 7.76
Syrian Arab Republic 50,985 291.33 2,968 16.96
French Polynesia 47,656 16,964.99 636 226.41
Gabon 45,909 2,062.65 300 13.48
Belize 45,753 11,506.48 616 154.92
Barbados 39,212 13,644.89 275 95.69
Burundi 37,042 311.52 14 0.12
Papua New Guinea 36,480 407.73 597 6.67
Togo 36,313 438.63 266 3.21
Mayotte 35,966 13,183.29 187 68.55
Guinea 35,857 273.03 414 3.15
Curaçao 35,307 21,516.46 210 127.98
Seychelles 35,178 35,769.27 136 138.29
Andorra 33,025 42,742.51 144 186.37
United Republic of Tanzania 32,393 54.23 753 1.26
Lesotho 32,049 1,496.05 690 32.21
Bahamas 31,915 8,115.83 726 184.62
Aruba 31,835 29,817.55 187 175.15
Mali 29,678 146.55 705 3.48
Haiti 28,250 247.75 780 6.84
Jersey 27,591 25,595.57 96 89.06
Benin 26,309 217.01 163 1.35
Somalia 24,322 153.03 1,335 8.40
Congo 23,485 425.60 371 6.72
Isle of Man 20,586 24,209.71 70 82.32
Guam 20,567 12,186.05 276 163.53
Burkina Faso 20,514 98.14 353 1.69
Timor-Leste 19,869 1,507.00 122 9.25
Saint Lucia 19,468 10,601.93 316 172.09
Tajikistan 17,578 184.30 125 1.31
South Sudan 16,711 149.29 137 1.22
Brunei Darussalam 16,132 3,687.49 59 13.49
Equatorial Guinea 15,690 1,118.33 179 12.76
New Caledonia 15,331 5,369.92 282 98.78
Djibouti 15,311 1,549.70 189 19.13
New Zealand 15,250 316.24 52 1.08
United States Virgin Islands 14,398 13,787.89 96 91.93
Faroe Islands 14,340 29,346.16 17 34.79
Cayman Islands 13,734 20,897.75 15 22.82
Nicaragua 13,646 205.99 219 3.31
Central African Republic 13,509 279.70 109 2.26
Gibraltar 11,810 35,053.87 100 296.82
San Marino 11,786 34,728.03 108 318.23
Gambia 11,572 478.84 347 14.36
Grenada 11,303 10,045.06 205 182.19
Guernsey 10,641 16,505.86 30 46.54
Yemen 10,585 35.49 1,995 6.69
Bermuda 9,766 15,682.56 112 179.85
Greenland 9,485 16,707.18 4 7.05
Eritrea 9,297 262.15 93 2.62
Saint Martin 9,143 23,650.38 40 103.47
Sint Maarten 8,965 20,906.21 77 179.56
Niger 8,544 35.30 296 1.22
Dominica 8,421 11,697.30 49 68.06
Liechtenstein 7,874 20,321.57 68 175.50
Comoros 7,812 898.34 159 18.28
Sierra Leone 7,590 95.15 125 1.57
Monaco 7,583 19,322.70 45 114.67
Guinea-Bissau 7,293 370.58 153 7.77
Liberia 7,243 143.21 289 5.71
Chad 6,889 41.94 185 1.13
Saint Vincent and the Grenadines 6,615 5,962.68 90 81.13
Antigua and Barbuda 5,931 6,056.43 122 124.58
Sao Tome and Principe 5,832 2,661.08 69 31.48
British Virgin Islands 5,649 18,682.41 47 155.44
Bonaire 5,594 26,746.35 26 124.31
Turks and Caicos Islands 5,570 14,386.07 33 85.23
Saint Kitts and Nevis 5,254 9,877.43 28 52.64
Northern Mariana Islands (Commonwealth of the) 4,246 7,377.04 22 38.22
Bhutan 3,811 493.90 3 0.39
Saint Barthélemy 3,282 33,201.82 4 40.47
Anguilla 2,187 14,578.06 7 46.66
Other 764 13
Palau 502 2,774.71 0 0.00
Saint Pierre and Miquelon 482 8,317.52 0 0.00
Wallis and Futuna 453 4,028.10 7 62.24
Solomon Islands 289 42.07 0 0.00
Sint Eustatius 280 8,920.04 1 31.86
Saba 198 10,243.15 0 0.00
Montserrat 155 3,100.62 1 20.00
Falkland Islands (Malvinas) 86 2,469.14 0 0.00
Kiribati 59 49.39 0 0.00
Holy See 26 3,213.84 0 0.00
American Samoa 18 32.61 0 0.00
Samoa 17 8.57 0 0.00
Vanuatu 7 2.28 0 0.00
Marshall Islands 4 6.76 0 0.00
Tonga 1 0.95 0 0.00
Cook Islands 0 0.00 0 0.00
Democratic People’s Republic of Korea 0 0.00 0 0.00
Micronesia (Federated States of) 0 0.00 0 0.00
Nauru 0 0.00 0 0.00
Niue 0 0.00 0 0.00
Pitcairn Islands 0 0.00 0 0.00
Saint Helena 0 0.00 0 0.00
Tokelau 0 0.00 0 0.00
Turkmenistan 0 0.00 0 0.00
Tuvalu 0 0.00 0 0.00
Download Excel Table

Global trend of cumulative total cases of COVID-19 and cumulative total death cases can be seen in Fig. 3 and 4 respectively. Unfortunately both trends are still rising up by at the end of December 2021.

lc-2-0-10-g3
Fig. 3. Global trend of cumulative total cases of SARS-CoV-2 infections by the WHO regions, since the outbreak of the COVID-19 pandemic to 31 January, 2022.
Download Original Figure
lc-2-0-10-g4
Fig. 4. Global trend of COVID-19 related deaths by the WHO regions, since the outbreak of the COVID-19 pandemic to 31 January, 2022.
Download Original Figure

4. Discussion

Present study showed a global picture of current COVID-19 epidemiology. Not only the number of cumulative total cases but cumulative incidence shown with number of cases per 100,000 population are highest in Europe region when compared with other WHO regions. Besides high-income group had the highest number of cumulative total cases and cumulative incidence. Although Americas group comes second after Europe in mean of cumulative total cases and cumulative incidence, WHO region of Americas includes not only high-income countries like USA and Canada but also middle and lower-income countries from South and Central America. Lower-income groups and regions of Africa which mostly consists from lower-income countries had reported the lowest total cumulative cases and cumulative incidence.

When total cumulative death cases and death rate defined as total cumulative death cases per 100,000 population calculations were analyzed, different outcome was found compared with total cumulative cases and cumulative incidence. Region of Americas data showed the highest cumulative total deaths and death rate. Europe comes second after Americas in mean of these two measures of WHO dashboard. Africa and Eastern Mediterranean are at the bottom of these measure lists.

It can be assumed that the economic inequality had influence on both the incidence and death rates of COVID-19. Although disproportionate impact of COVID-19 on different countries and regions can be conceived as arising from biological and genetic differences, it mostly comes from the social determinants of health-care systems.[14, 15] It is possible that the availability to medical access for COVID-19 testing may have impact on the high incidence of COVID-19 in the high-income group. The death rates of COVID-19 were high in developing or underdeveloped countries, although the incidence of COVID-19 was higher in many advanced countries. The higher death rates in developing or underdeveloped countries could be attributed to the shortage or insufficient medical care. These results support the prior reports on the economic inequalities during the COVID-19 pandemic.[14-16]

These results must be interpreted cautiously because one country comes forward with its measures of WHO COVID-19 Dashboard and socio-demoghraphic features. USA reported highest total cumulative cases and one of the high cumulative incidence. This result is in accordance with the region of Europe because developed or high-income countries usually reported high total cumulative cases and cumulative incidence attributed to the easy access to healthcare facilities. Despite its developed situation, USA has the highest total cumulative death cases and one of the highest death rate by 259 deaths per 100,000 population. USA is accepted as richest country on earth but it has heterogeneity for its citizens in mean of access to healthcare. Especially ethnic and racial minorities are more vulnerable to COVID-19 pandemic and death rates are higher in these groups when compared with their percentage in USA’s population.[17]

4.1 Global Trend of Incidence and Mortality of COVID-19

Almost two and a half years have been passed during pandemic when this paper was written. In the beginning of the pandemic, questions about the duration of the pandemic cannot be answered due its ambiguous nature. Despite many restrictions and prevention strategies have been implemented by various governments or organizations and introduction of various type of vaccine against SARS-CoV-2- as can be seen in Fig. 3 and 4 pandemic is still going on. It is expected not to end but to transform into endemic state.[18]

A number of factors can have influence on the incidence of COVID-19. The variant type of SARS-CoV-2 is one of the main factors in determining the infection rates of COVID-19. In January 2022, the omicron variant, a predominant mutant type of SARS-CoV-2, emerged, which had clinical characteristics of attenuated infections with mild or absence of symptoms, while it harbors high transmission rates.[19, 20]

The status of vaccination is another factor which has influence on the incidence of COVID-19. The COVID-19 vaccination reported to be effective in preventing and attenuating the infection rates of SARS-CoV-2 in many countries.[21, 22] However, because the novel variant of SARS-CoV-2 can escape most neutralizing antibodies against SARS-CoV-2, the high number of vaccinated population cannot guarantee a lower incidence of COVID-19.[23]

Public health measures, such as wearing facial mask can also have impact on the incidence of COVID-19. It was reported that the wearing of surgical masks reduced the SARS-CoV-2 infection rate more than 50% in Denmark.[24]

Another determinant of incidence of COVID-19 is testing strategies and the types of tests. Individuals who are offered test can affect the cumulative total case number and incidence. Individuals who had symptoms and individuals who had test for screening (for example before surgical interventions or before airway travelling) will show different test results. Tests for clinical purposes must have higher sensitivity. Reverse transcriptase PCR is the recommended test type for individuals who had symptoms. On the other hand for mass screening purposes and rapid antigen tests can be chosen given the lower cost but lower sensitivity.[25] Jurisdictions and governments had chosen different testing strategies, reporting practice based on their healthcare system and resources that affect the measures. Furthermore, lag times may have increase in reporting biases.

In this study, we suggested that the death rate was relatively high in developing or underdeveloped nations. The economic inequality for medical care may induce higher mortality rate in the developing or underdeveloped nations than developed nations. In addition, the epidemic features of SARS-CoV-2 variants could result in different mortality rates according to geographic regions. Some regions assumed to consist of low-income countries like Africa had reported lower numbers for all four measures of WHO COVID-19 Dashboard. We hypothesized that this difference come from the case detection methods and access to heathcare and data collection and reporting systems of jurisdictions. These kinds of health determinant may cause biases and incidence or death rate data cannot be collected adequately.

Death rate of COVID-19 is also affected by various types of determinants. In aspects of host factors, there have been reports on the different symptomatic characteristics of COVID-19 according to ethnicities.[26] The age of patients is another key factor to determine the fatality of SARS-CoV-2 infection.[27] In previous modeling study, the infection fatality of COVID-19 was estimated to be lowest in age groups of 5 to 9 years old and it increased according to age in a log-linear pattern.[27] Because the aged population is more vulnerable to the SARS-CoV-2 infection, the availability of nursing health care system and age distribution of the population are factors that could contribute to the heterogeneous mortality rates of COVID-19 among nations. In South Korea, the medical costs for diagnosis and treatment of COVID-19 have been completely covered by the national health insurance system.[28] This health care system may lead to the results of the low death rate of COVID-19 in South Korea.

4.2 Strengths and Limitations

It is notable that there are additional factors to be considered when estimating the mortality rates of COVID-19 in the future. The virulence of SARS-CoV-2 has been weakening with emergence of its novel variants. In addition, vaccinations against SARS-CoV-2 effectively attenuated the severity of COVID-19.[29] Because immunity of the disease has been maintained while the infection-blocking immunity rapidly disappeared, the immunologic features of SARS-CoV-2 are predicted to change and become endemic phase of COVID-19.[30]

In this study, we reported global, regional, and national incidence and mortality of COVID-19 in 237 countries and territories up to January 2022 through a systematic analysis for WHO COVID-19 Dashboard dataset. However, these are several limitations of this study that need to be addressed. First, every effort from WHO has been made to ensure the reliability and accuracy of the dataset, significant data errors could be detected. Second, as the data was collected by WHO, governments, international, national, and regional authorities, there is the possibility that the estimates may tend to underestimate or overestimate the levels of incidence and mortality of COVID-19.

5. Conclusions

From the start of the COVID-19 pandemic up to 31 January, 2022, 349.6 million of the worldwide population suffered symptoms of SARS-COV-2 and 5.6 million lost their lives due to it. The population in Europe and other high-income groups showed high incidence rates of COVID-19 while the death rate was high in Americas and other upper middle-income groups. According to figures nationalities, the counties with compromised social and economic status presented higher death rate despite the relatively lower incidence of COVID-19 than the developed countries. The results of this study may provide crucially important for COVID-19 research and proper public health policies and strategies.

Capsule Summary

From the start of the COVID-19 pandemic to 31 January, 2022, 349.6 million and 5.6 million of worldwide population each suffered and died from SARS-COV-2 infection.

Ethics statements

The study’s protocol has been approved by the research ethics board at the University of Washington. This dataset shall be conducted in full compliance with University of Washington policies and procedures, as well as applicable federal, state, and local laws.

Patient and public involvement

No patients were directly involved in designing the research question or in conducting the research. No patients were asked for advice on interpretation or writing up the results. There are no plans to involve patients or relevant patient community in dissemination at this moment.

Data availability statement

Data of the study are publicly available.

Transparency statement

The leading authors (Dr. SYK and AÖY) are an honest, accurate, and transparent account of the study being reported.

Acknowledgements

None

Author Contribution

Drs SYK and AÖY had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final version before submission. Study concept and design: SYK and AÖY; Acquisition, analysis, or interpretation of data: SYK and AÖY; Drafting of the manuscript: SYK and AÖY; Critical revision of the manuscript for important intellectual content: SYK and AÖY; Statistical analysis: SYK and AÖY; Study supervision: SYK and AÖY. SYK is guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Funding

This work was supported by the Bill and Melinda Gates Foundation.

Conflicts of Interest

The authors have no conflicts of interest to declare for this study.

Provenance and peer review

Not commissioned; externally peer reviewed.

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