Trends in case-fatality rates of COVID-19 in the World, between 2019 - 2020


  • Henrique de Moraes Bernal Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário Saúde ABC, André – SP – Brazil
  • Carlos Eduardo Siqueira School for the Environment, University of Massachusetts Boston. Boulevard, Boston. /Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  • Fernando Adami Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário Saúde ABC, André – SP – Brazil
  • Edige Felipe de Sousa Santos Laboratório de Delineamento de Estudos e Escrita Científica. Centro Universitário Saúde ABC. Santo André. São Paulo/ Faculdade de Saúde Pública, Universidade de São Paulo (USP), São Paulo, Brazil



COVID-19, Trends, Case-Fatality, Epidemiology


Introduction: CoV infections can potentially cause from a simple cold to a severe respiratory syndrome, such as the Severe Acute Respiratory Syndrome and the Middle East Respiratory Syndrome (MERS-CoV). The COVID-19 created a new reality for global healthcare models.

Objetive: To evaluate trends in case fatality rates of COVID-19 in the World.

Methods: We conducted a population based time-series study using public and official data of cases and deaths from COVID-19 in Argentina, Australia, Brazil, Chile, China, Colombia, France, Germany, India, Iran, Italy, Japan, Mexico, Morocco, New Zealand, Nigeria, Peru, Saudi Arabia, South Africa, South Korea, Spain, Switzerland, United Kingdom, United States and Russian, between December, 2019 and August, 2020. Data were based on reports from European Centre for Disease Prevention and Control. COVID-19 was defined by the International Classification of Diseases, 10th revision (U07.1). A Prais-Winsten regression model was performed and the Daily Percentage Change (DPC) calculated determine rates as increasing, decreasing or flat.

Results: During the study period, trends in case-fatality rates in the world were flat (DPC = 0.3; CI 95% [-0.2: 0.7]; p = 0.225). In Africa, Morocco had decreasing trends (DPC = -1.1; CI 95% [-1.5: -0.7]; p < 0.001), whereas it were increasing in South Africa (p < 0.05) and flat in Nigeria (p > 0.05). In the Americas, Argentina showed a decreasing trend in case-fatality rates (DPC = -0.6; CI 95% [-1.1: -0.2]; p = 0.005), the U.S. had flat trends (p > 0.05) and all other American countries had increasing trends (p < 0.05). In Asia, Iran had decreasing trends (DPC = -1.5; CI 95% [-2.6 : -0.2]; p = 0.019); China and Saudi Arabia showed increasing trends (p < 0.05), while in India, Japan and South Korea they were flat (p > 0.05). European countries had mostly increasing trends (p < 0.05): Germany, Italy, Spain, the UK and Russia; France and Switzerland had flat trends (p > 0.05). Finally, in Oceania, trends in case-fatality rates were flat in Australia (p > 0.05) and increasing in New Zealand (p < 0.05).

Conclusion: Trends in case-fatality rates of COVID-19 in the World were flat between December, 31 and August, 31. Argentina, Iran and Morocco were the only countries with decreasing trends. On the other hand, South Africa, Brazil, Canada, Chile, Colombia, Mexico, Peru, China, Saudi Arabia, Germany, Spain, United Kingdom, Russian and New Zealand had increasing trends in case-fatality rate. All the other countries analyzed had flat trends. Based on case-fatality rate data, our study supports that COVID-19 pandemic is still in progress worldwide.


Brasil. Ministério da Saúde. What coronavirus is? (COVID-19). [cited 2020 Mair 09] Available from:

Pimentel RMM, Daboin BEG, Oliveira AG, Macedo Jr H. The dissemination of COVID-19: an expectant and preventive role in global health. J Hum Growth Dev. 2020; 30(1): 135-140. DOI:

Phelan A, Katz R, Gostin LO. The Novel Coronavirus Originating in Wuhan, China: Challenges for Global Health Governance. JAMA. 2020; 323(8): 709-10. DOI:

World Health Organization (WHO). Available on:

Abreu LC. Integrated actions and strengthening of Public Health System in Brazil in a time of pandemic. J Hum Growth Dev. 2020; 30(1): 05-08. DOI:

Pandemic responses: Planning to neutralize SARSCoV-2 and prepare for future outbreaks. PLoS Med 17(4): e1003123. DOI:

Dircinha S. Scientific method and research in health: orientation for professional practice. J Hum Growth Dev. 2019; 29(1): 5-9. DOI:

Valenti VE, Menezes PL, de Abreu ACG, Alves Vieira GN, Garner DM. Social distancing measures could have reduced estimated deaths related to COVID-19 in Brazil. J Hum Growth Dev. 2020; 30(2):164-169. DOI:

Abou Ghayda R, Lee KH, Han YJ, et al. Estimation of global case fatality rate of coronavirus disease 2019 (COVID-19) using meta-analyses: Comparison between calendar date and days since the outbreak of the first confirmed case [published online ahead of print, 2020 Aug 31]. Int J Infect Dis. 2020; S1201-9712(20) 30694-9. DOI:

Antunes JLF, Cardoso MRA. [Using time series analysis in epidemiological studies]. Epidemiol Serv Saúde 2015; 24 (03) 565-576.

Calderon MG, Santos EFS, Abreu LC, Raimundo RD. Increasing prevalence, time trend and seasonality of gastroschisis in São Paulo state, Brazil, 2005-2016. Sci Rep. 2019; 9(1):14491. Published 2019 Oct 10. DOI:

Zeng W, Zhang Y, Wang L, et al. Ambient fine particulate pollution and daily morbidity of stroke in Chengdu, China. PLoS One. 2018; 13(11): e0206836. Published 2018 Nov 6. DOI:

Zhao X, Zhang B, Li Pet al. (2020). Incidence, clinical characteristics and prognostic factor of patients with COVID-19: A systematic review and meta-analysis. medRxiv 2020.03.17.20037572. DOI:

Abdollahi E, Champredon D, Langley JM, Galvani AP, Moghadas SM. Temporal estimates of case-fatality rate for COVID-19 outbreaks in Canada and the United States. CMAJ. 2020; 192(25): E666-E670. DOI: 10.1503/cmaj.200711.

Pachetti M, Marini B, Giudici F, et al. Impact of lockdown on Covid-19 case fatality rate and viral mutations spread in 7 countries in Europe and North America. J Transl Med. 2020; 18(1): 338. Published 2020 Sep 2. DOI:

Chin KL, Ofori-Asenso R, Jordan KA, Jones D, Liew D. Early signs that COVID-19 is being contained in Australia. J Infect. 2020; 81(2): 318-356. DOI:

Ouchetto O, Drissi Bourhanbour A, Boumhamdi M. Effectiveness of containment measures to control the spread of COVID-19 in North Africa [published online ahead of print, 2020 Sep 3]. Disaster Med Public Health Prep. 2020; 1-15. DOI: