Health inequality among different economies during early phase of COVID-19 pandemic

Abstract Background: New corona virus outbreak originated in Wuhan, China, started in January 2020 is escalating as pandemic across the globe in March 2020. It causes unprecedented morbidity, shocked health systems and the supply chains in new epicenters such as Italy, Spain and the US., claiming thousands of lives. Meanwhile, the pandemic is reaching swiftly and silently, to low-income countries where international medias cover less. How likely health outcomes among the countries with different economies may differ during the pandemic has not been reported yet.Method: We conducted analysis of COVID-19 deaths comparing case fatality rate (CRF) among countries with different income categories, applying COVID-19 global data from European Centre for Disease Control including 199 countries’ data as of 31 March 2020, in the early phase of pandemic. We categorized countries into high income countries (HIC), upper-middle income countries (UMIC), lower middle-income countries (LMIC) and low-income countries (LIC) according to World Bank classification by income as of 2020.Result: Statistically, countries in different income groups are significantly different in term of new cases identified in last two weeks and case-fatality rate. (Manova P value <0.001). New tests and detected case numbers shot up in HICs where CFR shot up in LMICs and LICs. The results of this analysis pointed out an important gap among countries with different economic status during ongoing pandemic.Discussion: In the HIC, contact tracing, testing capacity and outbreak response as well as clinical services are strong. In the LICs, there is low capacity of outbreak response which is reflected by the significantly lower number of diagnosis tests. Consequently, reported number of COVID-19 cases in LICs may not reflect the actual burden of the pandemic. Without effective prevention, the pandemic can readily break into the weak health system, and over-burden the hospitals, and clinical services in poor countries.Conclusion: This finding is showing health inequality between the rich and the poor being amplified by COVID-19 pandemic. Addressing such a gap though the local governance and integrated global responses will not only prevent unprecedented deaths, but also preserve the momentum towards SDGs