The Center for Systems Science and Engineering (CSSE) at Johns Hopkins University maintains a COVID-19 Dashboard which aggregates data from multiple sources to track global infections. Data is updated in near real-time throughout the day.

On April 16th the dashboard showed a total of 2,113,226 Confirmed Cases, with 140,371 Deaths globally. This results in a raw CFR, calculated simply by dividing the number of Confirmed Cases by the number of Deaths, of 6.6% (uncorrected for the 17-day delay period between reporting and death). This number also does not take into account the number of unreported asymptomatic cases, estimated by Imperial College London (ICL) to be as high as 19 times reported cases. Including unreported cases in the mortality equation produces the Infection Fatality Rate (IFR), a comparison of estimated Infections to Deaths. Applying the ICL 19:1 ratio, the global COVID-19 IFR would be 0.35%. Although an estimate, IFR is more representative of actual mortality.

A report published April 9th by the Cambridge University Press journal “Infection Control and Hospital Epidemiology” shows initial data in China, based upon wavelets and deterministic modelling, suggested that the ratio of unreported to reported cases could be as high as 1 to 1,104. Other sources suggest that 80% of cases are unreported. We will never know exactly, since most people infected with COVI-19 don't know that they are. Many think that they have the flu.  According to WHO Director General Tedros Adhanom, “Most people will have mild disease and get better without needing any special care.”

As of Apr 4th, there have been 42,475 Confirmed Cases of Influenza in Canada this season (IPAC). In 2018, Statistics Canada reported 8,511 deaths by Influenza and Pneumonia. The similarity in symptoms contributes directly to the number of unreported COVID-19 infections, introducing a significant variable into the data.

Referring to the CSSE data from April 16th, variations in mortality appear dramatic:

• Australia – 6,462 Confirmed – 63 Deaths = CFR 1.0%
• Belgium – 36,138 C – 5,163 D = 14.3%
• Canada – 30,436 C 1229 D = 4.0%
• Greece – 2,207 C 105 D = 4.7%
• Guinea – 438 C 1 D = 0.2%
• India – 12,759 C 423 D = 3.3%
• Israel – 12,758 C 142 D = 1.1%
• Italy – 168,941 C 22,170 D = 13.1%
• Mexico – 5,847 C 449 D = 7.7%
• Netherlands – 29,381 C 3,326 D = 11.3%
• New Zealand – 1,401 C 9 D = 0.6%
• Russia – 27,938 C 232 D = 0.8%
• Rwanda – 138 C 0 D = 0.0%
• Switzerland – 26,732 C 1,281 D = 4.8%
• UK – 104,135 C 13,755 D =13.2%
• US – 648,788 C 30,920 D = 4.7%.

Remarkably, the above data all refer to the same virus. The CFR ranges from 0% to 14%. Belgium is on the high end of the spectrum at an apocalyptic 14%. Canada is doing well at 4%, but no where near as well as New Zealand at 0.6%, or Australia at 1.0%. Surprisingly perhaps, Rwanda, with zero fatalities, appears to be the safest place to ride out the COVID-19 storm.

How can we account for human beings, infected with the same virus, suffering such geographical differences in mortality? How is it possible that 14 out of 100 confirmed patients in a highly developed Western country die, while a third-world country in Africa enjoys zero mortality? It seems counterintuitive.

Factors that affect reported CFR include:

• counting methodology
• testing protocols and availability
• confusion over CFI vs. IFR
• lack of peer-reviewed research data
• ascertainment bias (During an epidemic, doctors are more likely to attribute a death with complex causes as being caused by the disease in question).

It is also likely however, that immunal differences factor in the varying mortality rates. It is generally accepted by science that exposure to germs over time contributes to the development of a robust immune system, sometimes referred to as the “Hygiene Hypothesis”. In addition, genetic differences have been found to play a role. According to a 2016 study reported in Cell, researchers found that “differences between populations have been selected for over time because they conferred advantages to people facing distinct health challenges in the places where they lived. As a result, according to the new evidence, people of African ancestry generally show stronger immune responses than Europeans do.”

The reality is that, lacking standardization, current data do not support any meaningful conclusion regarding COVID-19 mortality.

Any high school science student would expect to have to repeat the experiment when attempting the course again next semester.