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. 2020 Jun;53(3):454-458.
doi: 10.1016/j.jmii.2020.03.013. Epub 2020 Mar 14.

Internationally lost COVID-19 cases

Hien Lau  1 , Veria Khosrawipour  2 , Piotr Kocbach  3 , Agata Mikolajczyk  4 , Hirohito Ichii  1 , Justyna Schubert  5 , Jacek Bania  5 , Tanja Khosrawipour  6
Affiliations

Internationally lost COVID-19 cases

Hien Lau et al. J Microbiol Immunol Infect. 2020 Jun.

Abstract

Background: With its epicenter in Wuhan, China, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO). While many countries have implemented flight restrictions to China, an increasing number of cases with or without travel background to China are confirmed daily. These developments support concerns on possible unidentified and unreported international COVID-19 cases, which could lead to new local disease epicenters.

Methods: We have analyzed all available data on the development of international COVID-19 cases from January 20th, 2020 until February 18th, 2020. COVID-19 cases with and without travel history to China were divided into cohorts according to the Healthcare Access and Quality Index (HAQ-Index) of each country. Chi-square and Post-hoc testing were performed.

Results: While COVID-19 cases with travel history to China seem to peak for each HAQ-cohort, the number of non-travel related COVID-19 cases seem to continuously increase in the HAQ-cohort of countries with higher medical standards. Further analyses demonstrate a significantly lower proportion of reported COVID-19 cases without travel history to China in countries with lower HAQ (HAQ I vs. HAQ II, posthoc p < 0.01).

Conclusions: Our data indicate that countries with lower HAQ-index may either underreport COVID-19 cases or are unable to adequately detect them. Although our data may be incomplete and must be interpreted with caution, inconsistencies in reporting COVID-19 cases is a serious problem which might sabotage efforts to contain the virus.

Keywords: COVID-19; Coronavirus; International; Lost; Pandemic; Unreported.

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Conflict of interest statement

Declaration of Competing Interest The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Development of international COVID-19 cases from January 20th, 2020 to February 18th, 2020 according to travel history to China. Beginning of lockdown in Wuhan (Hubei province) and major international flight restrictions.
Figure 2
Figure 2
Development of international COVID-19 cases from January 20th, 2020 to February 18th, 2020 for HAQ-A (A) and HAQ-B (B) according to travel history to China. Beginning of lockdown in Wuhan (Hubei province) and major international flight restrictions.
Figure 3
Figure 3
Total number of COVID-19 cases (for each HAQ A and B group). Case numbers according to the travel history with China and related statistical data.
See this image and copyright information in PMC

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