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Western Regional Minister makes misleading comparison about Ghana’s COVID-19 case fatality rate

Claim: Western Regional Minister Kwabena Okyere Darko-Mensah says that Ghana’s COVID-19 case fatality rate is better than that of other European countries such as Spain. He insists that the government’s investments in COVID-19 caused Ghana to record a low mortality rate.

Verdict: The claim is misleading. Scientists have shown that the case fatality rate that the minister attempted to use as the basis for comparison between Ghana and Spain is fundamentally flawed. Moreover, the case fatality rate between the two countries is the same. 

Full Text

Western Regional Minister and Member of Parliament for Takoradi, Kwabena Okyere Darko-Mensah, has mounted a spirited defense of the government’s assertion that the economy would have been better if not for the COVID-19 pandemic. 

Speaking to the press after the Finance Minister presented the 2024 budget on Wednesday, November 17, 2023, Kwabena Darko-Mensah said that the impact of the pandemic on the local economy could not be overemphasised.

He argued that the pandemic caused the government to suffer massive revenue shortfalls but had to expend more through COVID-19-related procurements and salaries.

“For COVID-19 alone, we could not collect some taxes at the port because people could not bring in imports… The COVID-19 expenses [on] sanitary products were so expensive, and the nurses that we had to top their pay [and] the teachers who stayed for almost a year but had to pay them,” he said.

“This country suffered because of COVID-19, and all over the world, everybody suffered,” he continued.

Mr Darko-Mensah drew comparisons between Ghana’s COVID-19 case situation and that of the U.S. and Spain. 

Verification

This report investigates three things: 

  • The COVID-19 case and fatality figures in Ghana, the USA, and Spain
  • A comparison of the case-fatality ratio for the three countries
  • What scientists have said about comparisons using the case fatality ratio

COVID-19 case and fatality figures

Using data from Johns Hopkins Coronavirus Resource Center, we found the following:

Source: John Hopkins Coronavirus Resource Center

What is the case fatality ratio?

“This is the proportion of individuals diagnosed with a disease who die from that disease and is, therefore, a measure of severity among detected cases,” according to the World Health Organization (WHO).

In other words, the case fatality ratio is the measure that estimates the proportion of deaths among identified confirmed cases. 

As can be seen in the data from the Johns Hopkins Coronavirus Resource Center, Ghana, and Spain have the same case fatality ratio (0.9%).

Although Ghana recorded fewer cases and deaths than Spain on face value, the proportion of deaths to the recorded cases of the two countries is the same. Therefore, it is misleading for anyone to assert that Ghana’s handling of COVID-19 was better just because of its death rate.

Why case fatality ratio is not a good measure for comparison

According to a scholarly article published in the National Library of Medicine, operated by the US government, the CFR is used to evaluate the severity of the pandemic in a particular location and the public health strategies needed to fight it. Countries with low CFRs believe they are on the right path to fighting the pandemic.  

But is the CFR a good measure to compare how two countries combat a disease?

The National Library of Medicine publication states that several other factors “affect the CFR of coronavirus disease 2019 (COVID-19), leading to false disparities between nations, especially resource-poor and fragile nations.”

For instance, differences in health infrastructure, availability of healthcare professionals, testing capacities between the two countries, as well as differences in socio-cultural and logistical support systems can affect the CFR of the two countries.

Also, the article states that “intentional or unintentional underreporting… can lead to inaccuracies in the CFRs between two countries.”

A concluding statement by the WHO in an article further underscores the limitations of using CFR to draw comparisons.

In addition, calculating the mortality rate per 100,000 population may not be accurate for comparing different countries because of varying population demographics. 

“The numbers of deaths per 100,000 population are influenced by the age distribution of the population. Two populations with the same age-specific mortality rates for a particular cause of death will have different overall death rates if the age distributions of their populations are different,” a publication by the WHO reads.

Government’s role in low deaths

When the African continent began recording COVID-19 cases, there were predictions of an impending disaster. American philanthropist Melinda Gates, for instance, said she foresaw bodies lying around in the streets of African countries.

Such predictions failed, and since then, scientists have tried to understand the ‘mystery’ behind Africa’s low COVID-19 mortality rate. 

One such scientist is Dr. Gordon Awandare, the Founding Director of the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) at the University of Ghana. Delivering his inaugural lecture at the University earlier this year, he explained Africans were better equipped to tolerate the pandemic due to exposure to malaria.

Responding to various social and religious theories about Africa’s low mortality rate, Prof. Awandare said:

“We cannot claim to have had better prevention measures or case management because there were not a lot of severe cases to begin with.”

A research paper published in the Journal of GlobalHealth also attempts to give a scientific perspective. Among its various hypotheses, the paper theorised that “Bacillus Calmette-Guérin (BCG) vaccination, primarily administered against tuberculosis, could play a protective role by promoting herd immunity against COVID-19.”

Conclusion

Using mortality rates as the basis for comparison does not tell an accurate story of how a country handled the COVID-19 pandemic. Therefore, the minister’s attempt at comparing Ghana’s COVID-19 fight against that of Spain and using CFR as a basis is misleading. 

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