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Population-level mortality burden from novel coronavirus (COVID-19) in Europe and North America.

ABSTRACT: As of 31 January 2021, 63.9 million cases and 1.4 million deaths had been reported in Europe and North America, which accounted for 62.5% and 62.4% of the global total, respectively. Comparing the level of mortality across countries has proven difficult because of inherent limitations in the most commonly cited measures (e.g., case-fatality rates). We collected the cumulative number of confirmed deaths from COVID-19 by age in 2020 from the L'Institut National d'études Démographiques (INED) database and Statistics Canada for 15 European and North American countries. We calculated age-specific death rates and age-standardized death rates (ASDR) for each country over a 1-year period from 6 February 2020 (date of first COVID-19 death in Europe and North America) to 5 February 2021 using established demographic methods. We estimated that COVID-19 was the second leading cause of death behind cancer in England and Wales and France and the third leading cause of death behind cancer and heart disease in nine countries including the US. Countries with higher all-cause mortality prior to the COVID-19 experienced higher COVID-19 mortality than countries with lower all-cause mortality prior to the pandemic. The COVID-19 ASDR varied substantially within country (e.g., a 5-fold difference among the highest and lowest mortality states in Germany). Consistently strong public health measures may have lessened the level of mortality for some European and North American countries. In contrast, many of the largest countries and economies in these regions may continue to experience a high mortality level because of poor implementation and adherence to such measures.

Supplementary information

The online version contains supplementary material available at 10.1186/s41118-021-00115-9.

SUBMITTER: Soneji S

PROVIDER: S-EPMC8050994 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background:Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of Years Lived with Disability (YLD) from the Global Burden of Disease (GBD) study help to characterise the extent of these effects. Our aim was to identify the countries across Europe that have populations at highest risk from COVID-19 by using estimates of population age structure and YLD for health conditions linked to severe illness from COVID-19. Methods:Population and YLD estimates from GBD 2017 were extracted for 45 countries in Europe. YLD was restricted to a list of specific health conditions associated with being at risk of developing severe consequences from COVID-19 based on guidance from the United Kingdom Government. This guidance also identified individuals aged 70 years and above as being at higher risk of developing severe health consequences. Study outcomes were defined as: (i) proportion of population aged 70 years and above; and (ii) rate of YLD for COVID-19 vulnerable health conditions across all ages. Bivariate groupings were established for each outcome and combined to establish overall population-level vulnerability. Results:Countries with the highest proportions of elderly residents were Italy, Greece, Germany, Portugal and Finland. When assessments of population-level YLD rates for COVID-19 vulnerable health conditions were made, the highest rates were observed for Bulgaria, Czechia, Croatia, Hungary and Bosnia and Herzegovina. A bivariate analysis indicated that the countries at high-risk across both measures of vulnerability were: Bulgaria; Portugal; Latvia; Lithuania; Greece; Germany; Estonia; and Sweden. Conclusion:Routine estimates of population structures and non-fatal burden of disease measures can be usefully combined to create composite indicators of vulnerability for rapid assessments, in this case to severe health consequences from COVID-19. Countries with available results for sub-national regions within their country, or national burden of disease studies that also use sub-national levels for burden quantifications, should consider using non-fatal burden of disease estimates to estimate geographical vulnerability to COVID-19.

Project description:BackgroundSevere acute respiratory syndrome CoV-2 (SARS-CoV-2) caused the first coronavirus disease 2019 (COVID-19) outbreak in China and has become a public health emergency of international concern. SARS-CoV-2 outbreak has been declared a pandemic by WHO on March 11th, 2020 and the same month several Countries put in place different lockdown restrictions and testing strategies in order to contain the spread of the virus.MethodsThe calculation of the Case Fatality Rate of SARS-CoV-2 in the Countries selected was made by using the data available at https://github.com/owid/covi-19-data/tree/master/public/data . Case fatality rate was calculated as the ratio between the death cases due to COVID-19, over the total number of SARS-CoV-2 reported cases 14 days before. Standard Case Fatality Rate values were normalized by the Country-specific ρ factor, i.e. the number of PCR tests/1 million inhabitants over the number of reported cases/1 million inhabitants. Case-fatality rates between Countries were compared using proportion test. Post-hoc analysis in the case of more than two groups was performed using pairwise comparison of proportions and p value was adjusted using Holm method. We also analyzed 487 genomic sequences from the GISAID database derived from patients infected by SARS-CoV-2 from January 2020 to April 2020 in Italy, Spain, Germany, France, Sweden, UK and USA. SARS-CoV-2 reference genome was obtained from the GenBank database (NC_045512.2). Genomes alignment was performed using Muscle and Jalview software. We, then, calculated the Case Fatality Rate of SARS-CoV-2 in the Countries selected.ResultsIn this study we analyse how different lockdown strategies and PCR testing capability adopted by Italy, France, Germany, Spain, Sweden, UK and USA have influenced the Case Fatality Rate and the viral mutations spread. We calculated case fatality rates by dividing the death number of a specific day by the number of patients with confirmed COVID-19 infection observed 14 days before and normalized by a ρ factor which takes into account the diagnostic PCR testing capability of each Country and the number of positive cases detected. We notice the stabilization of a clear pattern of mutations at sites nt241, nt3037, nt14408 and nt23403. A novel nonsynonymous SARS-CoV-2 mutation in the spike protein (nt24368) has been found in genomes sequenced in Sweden, which enacted a soft lockdown strategy.ConclusionsStrict lockdown strategies together with a wide diagnostic PCR testing of the population were correlated with a relevant decline of the case fatality rate in different Countries. The emergence of specific patterns of mutations concomitant with the decline in case fatality rate needs further confirmation and their biological significance remains unclear.

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Population-level mortality burden from novel coronavirus (COVID-19) in Europe and North America.

Supplementary information

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