Robust estimation of diagnostic rate and real incidence of COVID-19 for European policymakers

Abstract

Policymakers need a clear and fast assessment of the real spread of the epidemic of COVID-19 in each of their respective countries. Standard measures of the situation provided by the governments include reported positive cases and total deaths. While total deaths immediately indicate that countries like Italy and Spain have the worst situation as of mid April 2020, on its own, reported cases do not provide a correct picture of the situation. The reason is that different countries diagnose diversely and present very distinctive reported case fatality rate (CFR). The same levels of reported incidence and mortality might hide a very different underlying picture. Here we present a straightforward and robust estimation of the diagnostic rate in each European country. From that estimation we obtain an uniform unbiased incidence of the epidemic. The method to obtain the diagnostic rate is transparent and empiric. The key assumption of the method is that the real CFR in Europe of COVID-19 is not strongly country-dependent. We show that this number is not expected to be biased due to demography nor the way total deaths are reported. The estimation protocol has a dynamic nature, and it has been giving converging numbers for diagnostic rates in all European countries as of mid April 2020. From this diagnostic rate, policy makers can obtain an Effective Potential Growth (EPG) updated everyday providing an unbiased assessment of the countries with more potential to have an uncontrolled situation. The method developed will be used to track possible improvements on the diagnostic rate in European countries as the epidemic evolves. : medRxiv preprint countries [1-3]. However, comparative assessment of the spread of the pandemic in 4 other European countries has been more difficult to assess. The reason is that the real 5 incidence of the epidemic in each country can not be known with certainty because each 6 country is not able to perform the same number of PCR and consequently the 7 comparison of the ratio of those infected is difficult [4]. Policy responses have also 8 differed, with some countries focusing tests in its clinical use in hospitals, while others 9 have tried to use them, at least partially, to know some local chains of 10 transmissions [5,6]. The lack of clear cross country comparison in Europe can have deep 11 implications for the future structure of the UE since a lot of decisions are taken with a 12 heavy influence on the sense of in-country gravity. For these reasons, it is important to 13 have, at least, a proper measure of the relative spread of the epidemic. Policymakers 14 must know what is the real situation in their own countries in comparison to others so 15 that their decisions on the future of reopening and economic reconstruction are taken 16 not from false impressions but data. In this sense, policymakers must perceive the 17 method as unbiased, simple and robust. Most importantly, the relative comparisons 18 between countries must be as shielded as possible from the hypothesis of the method. In 19...

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