Articles Public Health Articles

Internationally Lost COVID-19 Cases

Published time: 13 March 2020

Authors: Hien LauVeria KhosrawipourPiotr KocbachAgata MikolajczykHirohito IchiiJustyna SchubertJacek BaniaTanja Khosrawipour

Keywords: Pandemic, Coronavirus, Unreported, International, COVID-19, Lost



With its epicenter in Wuhan, China, the COVID-19 outbreak wasdeclared a pandemic by the World Health Organization (WHO). While many countries have im-plemented flight restrictions to China, an increasing number of cases with or without travelbackground to China are confirmed daily. These developments support concerns on possibleunidentified and unreported international COVID-19 cases, which could lead to new local dis-ease epicenters.


We have analyzed all available data on the development of international COVID-19cases from January 20th, 2020 until February 18th, 2020. COVID-19 cases with and withouttravel history to China were divided into cohorts according to the Healthcare Access and Qual-ity Index (HAQ-Index) of each country. Chi-square and Post-hoc testing were performed.


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 signifi-cantly lower proportion of reported COVID-19 cases without travel history to China in countrieswith lower HAQ (HAQ I vs. HAQ II, posthoc p<0.01).


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

Internationally lost COVID-19 cases



Leave a Comment