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Coronavirus: covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate

BMJ 2020; 368 doi: (Published 18 February 2020) Cite this as: BMJ 2020;368:m641

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  1. Elisabeth Mahase
  1. The BMJ

The novel coronavirus that has so far spread from China to 26 countries around the world does not seem to be as “deadly as other coronaviruses including SARS and MERS,” the World Health Organization has said.

At a briefing on 17 February WHO’s director general, Tedros Adhanom Ghebreyesus, said that more than 80% of patients with covid-19 have a “mild disease and will recover” and that it is fatal in 2% of reported cases. In comparison, the 2003 outbreak of severe acute respiratory syndrome (SARS) had a case fatality rate of around 10% (8098 cases and 774 deaths), while Middle East respiratory syndrome (MERS) killed 34% of people with the illness between 2012 and 2019 (2494 cases and 858 deaths).12

However, despite the lower case fatality rate, covid-19 has so far resulted in more deaths (1871) than SARS and MERS combined (1632).

The latest update from China’s National Health Commission said that as at 17 February there had been 72 436 confirmed cases of the infection and 1868 deaths in the country. More than 12 500 patients have recovered and been discharged from hospital, while around 58 000 patients with confirmed cases (including 11 741 in a serious condition) and 6242 with suspected cases remain.

Outside China, WHO has reported 794 cases across 26 countries and three deaths.

Referencing a new paper from China that was based on 44 000 confirmed cases, Tedros said that 14% of cases of covid-19 were severe, causing pneumonia and shortness of breath, and that about 5% of patients had critical disease, including respiratory failure, septic shock, and multiorgan failure.

“As more data comes in from China, we’re starting to get a clearer picture of the outbreak, how it’s developing, and where it could be headed,” Tedros said. He added that while the data seemed to show a decline in the rate of new cases, the trend could change as new populations became affected.

This comment came after the first case of covid-19 was confirmed in Africa (in Egypt). Commenting on this milestone in the outbreak, Trudie Lang, director of the Global Health Network at the University of Oxford, said it was “important but not unexpected.” She highlighted the fact that WHO had declared the outbreak a “public health emergency” to “support less well resourced nations in responding and preparing for cases.”

Lang praised the response of the Africa Centres for Disease Control and Prevention, which is based in Ethiopia and supports countries with surveillance, emergency responses, and prevention of infectious disease. She said that the patient had been isolated, and all contacts had been found and tested (all negative). However, she added that a “key challenge” would be to ensure that countries across Africa had diagnostic capacity.

WHO is calling for donations to help it help countries prepare. It said that $675m was needed, and that though some contributions had been made, they “have not seen the urgency in funding that we need.”

WHO has been providing countries with testing kits, personal protective equipment, and training for health workers, as well as advice on how to do screening, testing, contact tracing, and treatment.

Tedros said, “We have a window of opportunity now. We need resources now to ensure countries are prepared now. We don’t know how long this window of opportunity will remain open. Let’s not squander it.”

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