Using a delay-adjusted case fatality ratio to estimate under-reporting

Status: Real time report | First online: 22-03-2020 | Last update: 02-06-2020

This study has not yet been peer reviewed.


To estimate the percentage of symptomatic COVID-19 cases reported in different countries using case fatality ratio estimates based on data from the ECDC, correcting for delays between confirmation-and-death.

Methods Summary

  • In real-time, dividing deaths-to-date by cases-to-date leads to a biased estimate of the case fatality ratio (CFR), because this calculation does not account for delays from confirmation of a case to death, and under-reporting of cases.

  • Using the distribution of the delay from hospitalisation-to-death for cases that are fatal, we can estimate how many cases so far are expected to have known outcomes (i.e. death or recovery), and hence adjust the naive estimates of CFR to account for these delays.

  • The adjusted CFR does not account for under-reporting. However, the best available estimates of CFR (adjusting or controlling for under-reporting) are in the 1% - 1.5% range [1–4]. Large studies in China and South Korea estimating the CFR at 1.38% (95% CrI: 1.23–1.53%)[2] and 1.4% (95% CrI: 1.2-1.7%)[4] respectively. Based on these studies, and for simplicity, we assume a baseline CFR of 1.4% for our analysis.

  • If a country has an adjusted CFR that is higher (e.g. 20%), it suggests that only a fraction of cases have been reported (in this case, 1.420=7.0% cases reported approximately).

Current estimates for percentage of symptomatic cases reported for countries with greater than ten deaths

Temporal variation