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Prevalence of severe illness and mortality among coronavirus disease (COVID-19) confirmed patients: A systematic review and meta-analysis.

Biruk Beletew Abate, Ayelign Mengesha Kasie, Mesfin Wudu Kassaw, Teshome Gebremeskel, Wubet Alebachew Bayih

Aim: The coronavirus disease (COVID-19) first identified in Wuhan, China in late 2019 as the cause of an outbreak of respiratory illness. It has rapidly spread around the world, and been declared a pandemic and Public Health Emergency of International Concern by the World Health Organization (WHO). As of 15 April 2020, this epidemic had spread to 210 countries with 2008 164 confirmed cases, including 127,152 deaths and 486,247 recovery. Objective: To assess the pooled prevalence of severe illness and mortality among COVID-19 confirmed cases. Methods: Using PRISMA guideline, we systematically reviewed and meta-analyzed studies that assessed the prevalence of severe illness and mortality among COVID-19 confirmed cases from PubMed, Cochrane library, and Google Scholar. Heterogeneity across the studies was evaluated using the Q and the I2 test. A weighted inverse variance random-effects model was applied to estimate the global magnitude of severe illness cases and mortality among COVID-19 confirmed cases. The subgroup analysis was done through stratification by sample size and by country. A funnel plot and Egger’s regression test were used to see publication bias. Sensitivity analysis was also done to identify the impact of studies on the pooled prevalence. Result: A total of 62 studies with 158870 participants were used for analysis. The pooled prevalence of severe illness was found to be 24.24(20.51-27.97; I2=99.2%; p<0.001). The pooled prevalence of mortality among COVID-19 confirmed cases was 4.41(3.59-5.24; I2=97.7%; p<0.001). In both outcomes the results of sensitivity analysis showed the findings were not dependent on a single study. Moreover a funnel plot showed symmetrical distribution. Egger’s regression test p-value was not significant, which indicates the absence of publication bias in both outcomes. Conclusions: Infection with COVID-19 is associated with significant severe illness and mortality. Nearly one 4th of COVID-19 cases in the world are severe and nearly one 25th of COVID-19 cases in the world end up with death. Additional studies regarding risk factors which determine severity and mortality due to COVID-19 is recommended. Everyone should take actions, such as hand washing with sanitizer, social distancing, avoid crowding (2m apart if coming together is a must), to help slow the spread of COVID-19 and protect older adults from severe illness.