08-14-2020, 08:49 AM
I'm sorry, I'm not seeing a paradox here. There have been 1,089,894 cases and 24,752 deaths in Africa as a whole. Thus naive CFR (deaths reported/cases reported) in Africa as a whole is 2.3%. In South Africa, which accounts for over half of the cases, you have 11,270 deaths and 572,865 reported cases, and a CFR of 2.0%. Thus outside of South Africa, the CFR is 2.6%. I'm guessing that a lot of the cases and a lot of the deaths are simply not being counted. Many don't even come in contact with the healthcare system, and die at home.
I compared that to some other poor to middle income countries. In South Asia, the CFR in India is 2.0%; in Pakistan it is 2.1%, in Bangladesh it is 1.3% and in Afghanistan it is 3.6%. In Southeast Asia, it is 1.7% in Indonesia and 1.6% in the Philippines. In South America, it is 2% in Argentina an 0.9% in Venezuela.
The numbers are higher in "hard hit" areas that have been overwhelmed. I think in those areas, like Spain, Italy, and the Northeast US, the observed CFR is much higher mostly because non-seriously ill patients were not tested. For example, the the CFR overall in the US is 3.1%; however outside of New York and New Jersey, the crude CFR is 2.5%.
So much of the numbers are dependent on who gets tested that looking at crude CFR is pretty meaningless. It would be most interesting to look at an estimate of IFR derived by comparing the total number of excess deaths by estimates of infected based on serology. In Spain, where that was best done the infection fatality rate for Spain as a whole was 1.15% and varied between 0.13% and 3.25% in the regions (https://www.mdpi.com/2079-7737/9/6/128/pdf), compared to a crude CFR of 8.0%.
In other words, using CFR is kind of pointless, because the biggest variable is how well the testing has been carried out.
BC
I compared that to some other poor to middle income countries. In South Asia, the CFR in India is 2.0%; in Pakistan it is 2.1%, in Bangladesh it is 1.3% and in Afghanistan it is 3.6%. In Southeast Asia, it is 1.7% in Indonesia and 1.6% in the Philippines. In South America, it is 2% in Argentina an 0.9% in Venezuela.
The numbers are higher in "hard hit" areas that have been overwhelmed. I think in those areas, like Spain, Italy, and the Northeast US, the observed CFR is much higher mostly because non-seriously ill patients were not tested. For example, the the CFR overall in the US is 3.1%; however outside of New York and New Jersey, the crude CFR is 2.5%.
So much of the numbers are dependent on who gets tested that looking at crude CFR is pretty meaningless. It would be most interesting to look at an estimate of IFR derived by comparing the total number of excess deaths by estimates of infected based on serology. In Spain, where that was best done the infection fatality rate for Spain as a whole was 1.15% and varied between 0.13% and 3.25% in the regions (https://www.mdpi.com/2079-7737/9/6/128/pdf), compared to a crude CFR of 8.0%.
In other words, using CFR is kind of pointless, because the biggest variable is how well the testing has been carried out.
BC