Co esponding au ho : Raiyan Hasha
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Global dispa i ies in COVID-19 mo ali y: A egional and popula ion-based analysis
Md Raiyan Hasha 1, *, Md Mahmudu Rahman Chowdhu y 2, Md Imam Hossain 3, Ajim Uddin 4 and Md Abdul
Ba i 5
1 Depa men o Public Heal h, Wo ld Uni e si y o Bangladesh.
2 Depa men o Respi a o y Medicine, Bangladesh Medical Uni e si y.
3 Sylhe MAG Osmani Medical College.
4 Depa men o Medicine, Dhaka Medical College Hospi al.
5 Depa men o Pha macology, Ibn Sina Medical College.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1493-1503
Publica ion his o y: Recei ed on 17 Ma ch 2025; e ised on 08 May 2025; accep ed on 10 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1769
Abs ac
This s udy examines global dispa i ies in COVID-19 mo ali y ac oss WHO egions and coun ies, u ilizing seconda y
da a om he WHO COVID-19 Dashboa d and Wo ld Bank popula ion es ima es. Desc ip i e s a is ical analyses e eal
signi ican a ia ions in mo ali y me ics. The A ican egion exhibi s he highes dea h- o-case a io a 1.93%, d i en
by unde epo ed cases and limi ed heal hca e access, while he Wes e n Paci ic egion eco ds he lowes a 0.20%,
e lec ing obus public heal h measu es. Globally, 80% o 7.78 million epo ed dea hs a e concen a ed in 24 coun ies,
wi h he U.S. (1.2 million dea hs) and India (533,000 dea hs) bea ing signi ican bu dens. Mexico and Pe u show he
highes case a ali y a es a 4.4% and 4.9%, espec i ely, indica ing unde epo ing o heal hca e s ain. In con as ,
China and Japan epo low mo ali y pe capi a due o s ingen in e en ions. The case s udy o Bangladesh highligh s
challenges in densely popula ed de eloping na ions, wi h a 1.44% dea h- o-case a io exceeding he global a e age o
1%. These indings unde sco e he need o equi able heal hca e esou ce alloca ion and s eng hened su eillance
sys ems o add ess dispa i ies and enhance global pandemic p epa edness.
Keywo ds: COVID-19 mo ali y; Global dispa i ies; Case a ali y a e; WHO egions; Popula ion-adjus ed analysis
1. In oduc ion
The co ona i us disease 2019 (COVID-19) pandemic, caused by he se e e acu e espi a o y synd ome co ona i us 2
(SARS-CoV-2), has undamen ally eshaped global heal h sys ems, exposed dispa i ies in heal hca e in as uc u e, and
challenged public heal h p epa edness in bo h de eloped and de eloping na ions (Sawicka e al., 2022). Since i s
eme gence in la e 2019, he i us has sp ead ac oss i ually e e y coun y, esul ing in o e 778 million con i med
cases and 7.1 million epo ed dea hs as o ea ly 2025, acco ding o he Wo ld Heal h O ganiza ion (WHO). While
COVID-19 is a uni e sal heal h challenge, i s impac has been a om uni o m ac oss egions, coun ies, and
demog aphic g oups.
The global mo ali y bu den om COVID-19 has a ied signi ican ly, d i en by a complex in e play o ac o s including
heal hca e sys em capaci y, popula ion demog aphics, i al a ian s, accina ion co e age, public heal h policy, and
socioeconomic inequali ies. Fo ins ance, some egions ha e epo ed high in ec ion a es bu compa a i ely low dea h
a es, whe eas o he s, pa icula ly ce ain coun ies in he Ame icas and Eas e n Medi e anean egions, ha e
expe ienced disp opo iona ely high case a ali y a es (CFRs) (Kha aie & Rahim, 2020). These dispa i ies p omp
u gen ques ions abou he s uc u al and sys emic ac o s unde lying COVID-19 ou comes.
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Epidemiological compa isons be ween na ions o e aluable insigh s in o public heal h ulne abili ies and policy
e ec i eness. Howe e , compa ing c ude dea h coun s wi hou adjus ing o popula ion size, es ing a es, and epea
in ec ions can be misleading. Mo ali y indica o s such as he case a ali y a e (CFR) and mo ali y a e pe 100,000
popula ion p o ide mo e nuanced iews bu a e s ill subjec o a ia ion in es ing s a egies and epo ing accu acy.
An addi ional laye o complexi y a ises when compa ing mo ali y ela i e o popula ion size. Coun ies wi h e y la ge
popula ions, such as China and India, ha e shown ela i ely low mo ali y a es pe capi a despi e high absolu e case
numbe s. Con e sely, coun ies wi h smalle popula ions, such as Pe u and Mexico, ha e eco ded some o he highes
COVID-19 dea h a es in ela ion o hei popula ion size and con i med cases. These dispa i ies sugges ha popula ion-
adjus ed analyses a e essen ial o p ope ly assess and in e p e he global impac o COVID-19.
Fu he , he egional classi ica ion p o ided by he WHO, including he A ican, Eas e n Medi e anean, Eu opean,
Wes e n Paci ic, Sou h-Eas Asian, and Ame ican egions, o e s a use ul amewo k o compa e ou comes in a
geog aphically and adminis a i ely s anda dized way. No ably, coun ies in he Wes e n Paci ic egion, despi e
expe iencing signi ican caseloads, ha e main ained ela i ely low mo ali y, p omp ing inqui ies in o egional
s a egies and sys em-le el esilience. In con as , se e al na ions in he Ame icas and Eas e n Medi e anean egions
ha e consis en ly exhibi ed highe dea h- o-case a ios.
Despi e a as and g owing body o COVID-19 li e a u e, he e emains a signi ican gap in compa a i e analyses ha
simul aneously accoun o :
● The concen a ion o global dea hs in a small g oup o coun ies,
● The di e ences in dea h- o-case a ios ac oss WHO egions,
● The ole o popula ion size in shaping mo ali y a es.
Mos exis ing s udies ei he ocus on clinical o i ological aspec s o he disease o a e coun y-speci ic and lack a
b oade compa a i e pe spec i e. Mo eo e , while aw da a is a ailable om global sou ces, ew desc ip i e s udies
ha e syn hesized hese da a o map pa e ns o mo ali y and case bu den ac oss he globe using consis en s a is ical
app oaches.
This s udy aims o add ess hese gaps h ough a comp ehensi e desc ip i e s a is ical analysis o COVID-19 cases and
dea hs ac oss WHO egions and key coun ies. The speci ic objec i es a e:
● To iden i y and analyze dispa i ies in COVID-19 mo ali y ac oss di e en WHO egions
● To examine he concen a ion o global COVID-19 dea hs among a small g oup o coun ies, and o assess how
much o he global dea h bu den is accoun ed o by hem.
● To compa e coun y-le el mo ali y in he con ex o popula ion size, highligh ing he con as be ween
absolu e and ela i e mo ali y bu dens.
● To discuss po en ial epidemiological, demog aphic, and heal h sys em ac o s ha may explain hese egional
and coun y-le el dispa i ies.
This s udy uses seconda y da a om he Wo ld Heal h O ganiza ion (WHO) COVID-19 Dashboa d and publicly a ailable
na ional-le el da ase s. The mos ecen cumula i e s a is ics on epo ed cases and dea hs a e u ilized, wi h egional
ca ego iza ions based on WHO classi ica ions. Popula ion da a a e ob ained om he Uni ed Na ions Wo ld Popula ion
P ospec s (2022 e ision) o compu e popula ion-adjus ed indica o s.
A desc ip i e s a is ical app oach is employed o explo e ends and pa e ns. Key me ics include:
● Case Fa ali y Ra e (CFR): dea hs as a pe cen age o con i med cases,
● Mo ali y pe 100,000 popula ion, and
● P opo ional con ibu ion o each coun y o o al global dea hs.
Visualiza ions such as ba cha s, hea maps, and egional compa isons a e used o suppo he analysis.
No in e en ial o p edic i e modeling is applied in his s udy, as he p ima y objec i e is o desc ibe, summa ize, and
compa e mo ali y me ics ac oss geog aphies in an epidemiologically meaning ul manne .
Unde s anding whe e and why mo ali y dispa i ies exis is c i ical o u u e pandemic p epa edness and o
s eng hening global heal h equi y. This esea ch p o ides ounda ional insigh s o policymake s, epidemiologis s, and
public heal h s akeholde s by:
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● Highligh ing na ions and egions wi h disp opo iona ely high dea h a es ela i e o case coun s and
popula ion sizes,
● In o ming u u e heal h esou ce alloca ion and in e na ional collabo a ion e o s,
● Encou aging deepe in es iga ions in o heal hca e access, como bidi y pa e ns, es ing a ailabili y, and
epo ing p ac ices.
Fu he mo e, hese indings could guide u u e esponse s a egies no only o COVID-19 bu also o o he
communicable disease ou b eaks. By iden i ying pa e ns o ulne abili y and esilience, his s udy con ibu es o global
lessons in p epa edness, su eillance, and equi y.
2. Li e a u e Re iew
The COVID-19 pandemic has un eiled signi ican dispa i ies in mo ali y a es ac oss di e en egions, popula ions, and
heal hca e sys ems. Nume ous s udies ha e explo ed hese dispa i ies, highligh ing he mul i ace ed na u e o COVID-
19 ou comes in luenced by socioeconomic, acial, and egional ac o s.
Racial and e hnic dispa i ies ha e been a p ominen ea u e o COVID-19 mo ali y s a is ics. A s udy published in JAMA
Ne wo k Open analyzed age-adjus ed mo ali y a es ac oss a ious acial and e hnic g oups in he Uni ed S a es om
Feb ua y 2020 o Sep embe 2023 (Albuque que e al., 2022). The indings e ealed ha non-Hispanic Ame ican Indian
o Alaska Na i e and non-Hispanic Na i e Hawaiian o Paci ic Islande popula ions consis en ly exhibi ed highe
mo ali y a es compa ed o non-Hispanic Whi e indi iduals. These dispa i ies we e pa icula ly p onounced du ing
COVID-19 su ges, unde sco ing he pe sis en heal h inequi ies aced by hese communi ies.
Simila ly, a s udy highligh ed in Time magazine emphasized ha people o colo in he U.S., ega dless o income le el,
disp opo iona ely su e ed highe a es o COVID-19 in ec ion and mo ali y. The esea ch indica ed ha s uc u al
acism ex ends beyond income dispa i ies, a ec ing access o medical ca e, job ypes, and exposu e o s esso s, he eby
exace ba ing heal h ou comes du ing he pandemic (Chen e al, 2025).
Regional dispa i ies also played a signi ican ole in COVID-19 mo ali y (Sumibcay e al., 2024). A e ospec i e analysis
conduc ed in On a io, Canada, examined he e ec s o dep i a ion, age, and egional di e ences on COVID-19 mo ali y
om 2020 o 2022. The s udy ound ha a eas wi h highe dep i a ion le els expe ienced inc eased mo ali y a es,
highligh ing he in e sec ion o socioeconomic s a us and heal h ou comes.
In he Uni ed S a es, nu sing homes wi h lowe p opo ions o whi e esiden s saw signi ican ly highe COVID-19 dea h
a es compa ed o hose wi h p edominan ly whi e popula ions (Time S a , 2020). This dispa i y was a ibu ed o he
mo e se e e sp ead o he disease in non-whi e communi ies and he speci ic cha ac e is ics o he nu sing homes
se ing hese popula ions.
T ea men dispa i ies ha e also in luenced COVID-19 mo ali y ou comes. A Bayesian eanalysis published in JAMA
Ne wo k Open assessed he mo ali y a es among hospi alized COVID-19 pa ien s ea ed wi h ocilizumab and
co icos e oids (Axios S a , 2021). The s udy concluded ha pa ien s ecei ing simple oxygen o nonin asi e
en ila ion bene i ed om ocilizumab ea men , while he bene i was unce ain o hose equi ing in asi e
mechanical en ila ion.
While he s udies p ima ily ocus on high-income coun ies, he implica ions a e ele an o coun ies like Bangladesh.
Unde s anding he in e play o acial, socioeconomic, and egional ac o s in COVID-19 mo ali y can in o m public
heal h s a egies o add ess dispa i ies. Gi en Bangladesh's di e se popula ion and a ying access o heal hca e
esou ces, simila analyses a e essen ial o iden i y ulne able g oups and ailo in e en ions acco dingly.
3. Me hodology
3.1. S udy Design
This s udy adop s a e ospec i e, c oss-sec ional design using publicly a ailable seconda y da a o assess global
dispa i ies in COVID-19 mo ali y. The analysis ocuses on egional and coun y-le el di e ences in COVID-19 dea h
a es in ela ion o epo ed cases and popula ion sizes.
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3.2. Da a Sou ces
Da a we e collec ed om epu able, open-access da abases including:
● Wo ld Heal h O ganiza ion (WHO) COVID-19 Dashboa d
● Ou Wo ld in Da a (OWID) COVID-19 da ase
● Wo ld Bank o popula ion es ima es and heal hca e indica o s
These sou ces o e comp ehensi e and egula ly upda ed da ase s on con i med cases, dea hs, es ing a es, and
popula ion s a is ics ac oss coun ies and egions.
3.3. Inclusion C i e ia
● Coun ies and WHO egions wi h a leas 100,000 epo ed COVID-19 cases.
● A ailabili y o cumula i e da a o o al con i med cases, dea hs, and na ional popula ion.
Coun ies wi h signi ican unde epo ing o missing da a we e excluded o main ain analy ical eliabili y.
3.4. Va iables and De ini ions
● To al Repo ed Cases (C): Cumula i e con i med COVID-19 cases.
● To al Repo ed Dea hs (D): Cumula i e con i med COVID-19- ela ed dea hs.
● Popula ion (P): To al na ional popula ion as epo ed by he Wo ld Bank.
● Case Fa ali y Ra e (CFR): Ra io o dea hs o con i med cases.
● Mo ali y pe 100,000 Popula ion (M): Dea hs pe capi a, s anda dized.
3.5. Da a Analysis
The analysis employed desc ip i e s a is ical echniques using Mic oso Excel and Py hon (pandas, seabo n, ma plo lib)
o explo e pa e ns in COVID-19 mo ali y. Regional and coun y-le el summa ies we e c ea ed based on WHO egional
classi ica ions.
The ollowing me ics we e compu ed:
3.5.1. Case Fa ali y Ra e (CFR)
CFR% = 𝐷
𝐶 𝑋 100
3.5.2. Mo ali y Ra e pe 100,000 Popula ion (MR)
MR = 𝐷
𝑃 𝑋 100,000
3.5.3. In ec ion Pene a ion Ra e (IPR):
To al epo ed cases as a p opo ion o he popula ion
IPR% = 𝐶
𝑃 𝑋 100
3.5.4. Con ibu ion o Global Dea hs (CDG):
P opo ion o global dea hs a ibu ed o each coun y
CDG% = 𝐷𝑖
𝐷𝑡𝑜𝑡𝑎𝑙
𝑋 100
Whe e:
D: To al dea hs in he coun y; C: To al cases in he coun y; P: To al popula ion o he coun y; Di: Dea hs in coun y i;
D o al: Global o al dea hs.
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3.6. Regional Compa ison
Coun ies we e g ouped in o he six WHO egions: A ican Region (AFR); Region o he Ame icas (AMR); Sou h-Eas
Asia Region (SEAR); Eu opean Region (EUR); Eas e n Medi e anean Region (EMR); Wes e n Paci ic Region (WPR)
Desc ip i e compa isons o CFR and MR we e conduc ed be ween egions o iden i y which egions expe ienced
disp opo iona ely high o low mo ali y bu dens.
3.7. Visualiza ion and S a is ical Tools
Da a isualiza ions (e.g. ba g aphs, hea maps, sca e plo s) we e used o illus a e egional and coun y-le el pa e ns.
Analysis was desc ip i e in na u e, wi hou in e en ial s a is ical es ing, due o he ecological na u e o he da a and
a iabili y in na ional epo ing s anda ds.
3.8. E hical Conside a ions
As his s udy uses only seconda y, publicly a ailable, and agg ega ed da a, no e hical app o al was equi ed. No pe sonal
o con iden ial heal h in o ma ion was used.
4. Resul s and Discussion
Table 1 shows he esul s o zone-wise case and dea h a e-
Table 1 Zone-wise case and dea h a e ac oss he wo ld
Region
Dea hs
Case
Dea h/Case
AFRO
174426
9051672
1.93%
AMRO
3053194
192982520
1.58%
EMRO
351975
23417911
1.50%
EURO
2280007
281013542
0.81%
SEARO
808873
61332835
1.32%
WPRO
421686
208610782
0.20%
G and To al
7090161
776409262
0.20%
Acco ding o his esul , he A ican egion shows he highes dea h- o-case a io (1.93%) among all WHO egions. Many
A ican na ions may ha e unde epo ed o al cases due o weak su eillance sys ems and es ing capaci y. This leads
o in la ed dea h/case a ios because he denomina o (case coun ) is unde es ima ed.
Access o in ensi e ca e, oxygen he apy, and ad anced ea men s a e o en limi ed in many pa s o A ica. Delayed
iden i ica ion o COVID-19 cases due o low es ing may esul in highe mo ali y once cases a e de ec ed.
Despi e being be e esou ced, he Ame icas show a signi ican ly high dea h/case a io. The Ame icas ha e a high
p e alence o obesi y, diabe es, and ca dio ascula diseases, all o which inc ease COVID-19 mo ali y. Coun ies like
he USA and B azil aced ea ly challenges in esponse s a egies, heal hca e o e load, and accine ollou . Ma ginalized
popula ions (e.g., low-income o indigenous g oups) had educed access o ca e and we e disp opo iona ely a ec ed.
Also, abo e he global a e age, EMRO includes coun ies like I an, Pakis an, and Egyp . Con lic zones and agile heal h
sys ems (e.g., Sy ia, Yemen) likely educed access o p ope heal hca e and led o unde epo ing o mild/mode a e
cases. Limi ed da a anspa ency in some coun ies migh also skew he a io.
Sou h-Eas Asia Region (SEARO) – 1.32%. Includes densely popula ed coun ies like India, Bangladesh, and Indonesia.
In coun ies like India and Bangladesh, he shee size o he popula ion and esou ce limi a ions could ha e educed
es ing co e age. Unde ec ed mild cases educe he o icial case coun , making he dea h- o-case a io appea highe
han i uly is.
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Eu opean Region (EURO) – 0.81%. Eu ope shows a ela i ely mode a e dea h/case a io despi e high case numbe s.
Widesp ead es ing inc eased he numbe o de ec ed (including asymp oma ic and mild) cases, lowe ing he
dea h/case a io. The a ailabili y o ICU beds, en ila o s, and ea ly in e en ion helped educe a ali y a es. High
accine co e age played a c ucial ole in minimizing se e e ou comes.
Lowes Dea h- o-Case Ra io: Wes e n Paci ic Region (WPRO) – 0.20%. Coun ies like China, Japan, Sou h Ko ea, and
Aus alia all in his egion. S ic lockdowns, bo de con ol, and ea ly in e en ions slowed i us sp ead. Mask-wea ing
and social dis ancing we e widely p ac iced. High accina ion a es and s ong heal hca e sys ems, pa icula ly in
coun ies like Japan and Aus alia. Accu a e es ing and epo ing inc eased he denomina o (cases), lowe ing he a io.
Table 2 shows ha 80% o he o al dea h occu ed only in 24 coun ies as epo ed.
Table 2 80% o he dea h occu ed in 24 coun ies
Coun ies
Sum o New_dea hs
Sum o New_cases
Popula ion
Uni ed S a es o Ame ica
1222309
103436829
336998000
B azil
702747
37715366
214326000
India
533664
45044634
1407564000
Russian Fede a ion
404290
24901467
145103000
Mexico
334818
7622513
126705000
Uni ed Kingdom
232112
25040433
67281000
Pe u
221051
4532174
33715000
I aly
198519
26968272
59240000
Ge many
174979
38437863
83409000
F ance
168162
39037633
64531000
Indonesia
162059
6830227
273753000
I an (Islamic Republic o )
146837
7627863
87923000
Colombia
142755
6397671
51517000
A gen ina
130750
10112153
45277000
China
122398
99381761
1425894000
Spain
121852
13980340
47487000
Poland
121018
6779266
38308000
Uk aine
109925
5543240
43531000
Sou h A ica
102595
4072955
59392000
Tu key
101419
17004713
84775000
Japan
74694
33803572
124613000
Romania
68963
3568885
19329000
Philippines
66864
4140383
113880000
Chile
62872
5410137
19493000
G and To al
5727652
577390350
4974044000
A cho ople h map can desc ibe he scena io wi h enhanced cla i y.
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Figu e 1 80% dea h due o Co id 19 occu ed in only 24 coun ies
Based on he esul s, he e a e he mos c i ical COVID-19 impac scena ios d awn om dea hs, cases, and popula ion
igu es:
4.1. High Dea h Toll wi h High Popula ion – India & USA
● India: Though i had o e 533,000 dea hs, his is ela i ely low pe capi a due o i s la ge popula ion (1.4
billion). I s dea h a e pe 100,000 popula ion is signi ican ly lowe han mos op coun ies.
● USA: The highes numbe o dea hs (1.2 million) and highes cases (103 million). E en wi h high es ing and
heal hca e, he dea h oll e lec s ea ly-s age policy gaps and widesp ead ansmission.
4.2. Highes Case Fa ali y Ra io (Dea hs pe Case) – Mexico & Pe u
● Mexico: 334,818 dea hs wi h only 7.6 million cases → app ox. 4.4% case a ali y a e.
● Pe u: 221,051 dea hs and 4.5 million cases → app ox. 4.9%, he highes globally.
● These high a es sugges unde epo ing o mild cases, poo es ing, and/o weake heal hca e esponses.
4.3. La ge Case Coun s bu Mode a e Mo ali y – F ance, Ge many, UK
● These coun ies epo ed 25M–39M cases, bu dea h a es emained compa a i ely lowe (0.4–0.7%).
● Indica es e ec i e public heal h measu es, accina ions, and heal hca e capaci y.
4.4. Low Dea hs Rela i e o Popula ion – China & Japan
● China: ~122,000 dea hs wi h 99 million cases, bu a popula ion o 1.42 billion → e y low mo ali y pe capi a.
● Japan: Despi e 33.8 million cases, only 74,694 dea hs → ex emely low case a ali y a e (~0.2%).
● Bo h bene i ed om s ingen con ol measu es, ea ly in e en ion, and public compliance.
4.5. Unde ep esen ed In ec ion – Indonesia & Philippines
● Bo h ha e la ge popula ions (Indonesia: 274M, Philippines: 114M) bu ela i ely low case coun s.
● Likely due o limi ed es ing/ epo ing, no necessa ily lowe ansmission.
O e 80% o he o al 7.78 million epo ed COVID-19 dea hs a e concen a ed in jus 24 coun ies, wi h an a e age
global case a ali y a e o a ound 1%. Among hese, Mexico leads wi h an excep ionally high dea h- o-case a io o
app oxima ely 4–5%, indica ing ei he se e e unde epo ing o cases o a s ained heal hca e esponse. Al hough Pe u
has one o he highes a ali y a ios globally, i is no included among he op 24 con ibu o s o o al dea hs due o i s
ela i ely lowe numbe o epo ed cases. In con as , coun ies like China, Japan, and Sou h Ko ea demons a e he
mos a o able ou comes, wi h e y low dea h- o-case a ios, e lec ing e ec i e con ainmen and heal hca e s a egies.
Addi ionally, China and India epo he lowes mo ali y a es ela i e o hei o al popula ions, la gely due o hei
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1493-1503
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massi e popula ion sizes dilu ing he pe capi a impac . In e ms o case- o-popula ion a ios, coun ies wi h mo e
ex ensi e es ing acili ies, such as hose in Eu ope and No h Ame ica, na u ally show highe pe cen ages, unde sco ing
he ole o es ing capaci y in epo ed in ec ion da a.
Figu e 2 Top en coun ies wi h maximum dea h/case
The op en coun ies (Figu e 2) wi h he highes dea h- o-case a ios exhibi ala mingly high a ali y a es, indica ing
se e e heal hca e challenges o unde epo ing o cases. Yemen leads wi h a s agge ing 18.1% dea h- o-case a io,
sugges ing an o e whelmed heal h sys em amid ongoing con lic . Sudan (7.9%), Sy ia (5.5%), and Somalia (5.0%) ollow
closely—coun ies simila ly a ec ed by poli ical ins abili y o agile heal hca e in as uc u es. Pe u (4.9%) and
Mexico (4.4%) a e no able excep ions om La in Ame ica, likely a ec ed by delayed es ing and epo ing. Egyp (4.8%)
and Bosnia and He zego ina (4.1%) e lec he s uggle o middle-income coun ies o manage case su ges. E en
coun ies like Libe ia (3.7%) and A ghanis an (3.4%) epo high a ios, likely due o limi ed access o heal hca e and
es ing. These high dea h- o-case a ios e lec he need o s eng hened heal h sys ems, imely diagnosis, and equi able
accine dis ibu ion, especially in ulne able and con lic -a ec ed egions.
Figu e 3 Co id cases and dea hs o e ime
The peak in epo ed cases, which occu ed om he las qua e o 2021 o Feb ua y 2023, appea s o coincide wi h a
signi ican decline in epo ed dea hs s a ing in Ma ch 2022 (Figu e 3). This sugges s a po en ial ela ionship be ween
he peak in cases and he subsequen dec ease in dea hs. No ably, he highes numbe o dea hs occu ed du ing he
second hal o 2020 o he i s hal o 2021, possibly indica ing a pe iod o mo e se e e impac . The decline in dea hs
a e Ma ch 2022 could be a ibu ed o imp o ed heal hca e esponses, accina ion e o s, o o he mi iga ing ac o s.
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5. Case S udy o Bangladesh: A Densely Popula ed De eloping Economy
In Bangladesh, he dea h- o-case a io o 1.44% exceeds he global a e age o 1%, sugges ing ha many COVID-19 cases
may ha e been iden i ied only a e dea h o ha he e was a lack o es ing acili ies du ing c i ical pe iods. The case-
o-popula ion a io o 1.21% aligns closely wi h coun ies like India, whe e limi ed heal hca e in as uc u e and es ing
a ailabili y con ibu e o lowe de ec ion a es. The ela i ely low dea h- o-popula ion a io can be a ibu ed o he
coun y's la ge popula ion size, al hough popula ion densi y may no be a signi ican ac o in his con ex . Bo h cases
and dea hs peaked in 2021, e lec ing he se e i y o he pandemic du ing ha yea .
The COVID-19 pandemic p esen ed se e e challenges o bo h he people o Bangladesh and i s heal hca e sys em,
highligh ing he coun y's ulne abili ies in handling la ge-scale public heal h c ises (Debna h e al., 2024). One o he
mos ex eme challenges aced by he Bangladeshi popula ion was he o e whelming p essu e on he heal hca e
in as uc u e. Wi h a dense popula ion and limi ed medical esou ces, he heal hca e sys em was ill-equipped o handle
he su ge in COVID-19 cases. Hospi als we e quickly o e whelmed wi h pa ien s, and he e was a sho age o essen ial
medical supplies, including pe sonal p o ec i e equipmen (PPE), en ila o s, and oxygen cylinde s. As he i us sp ead
apidly, he al eady s ained heal hca e sys em became e en mo e bu dened, leading o inadequa e ca e o many
pa ien s and an inc ease in p e en able dea hs.
Compounding he si ua ion was he lack o a obus es ing in as uc u e. Ini ially, es ing capaci y was ex emely
limi ed, which esul ed in delayed diagnoses and made i di icul o ack he ue sp ead o he i us. Many people in
Bangladesh we e unawa e o hei COVID-19 s a us un il hey de eloped se e e symp oms, by which ime he i us had
al eady sp ead wi hin households and communi ies. This lack o ea ly de ec ion con ibu ed o he apid ansmission
o he i us and made con ainmen e o s e en mo e challenging. The widesp ead ea o he unknown also led o a
sense o panic, as people sough medical help only when hei condi ions wo sened, o en oo la e o e ec i e
in e en ion.
In addi ion o he s ain on he heal hca e sys em, he pandemic exposed signi ican gaps in he social sa e y ne , lea ing
many ulne able g oups wi hou adequa e suppo . Wi h businesses o ced o close and many wo ke s in he in o mal
sec o losing hei li elihoods, millions o Bangladeshis aced economic ha dship. The sudden hal in daily wage
ea nings, combined wi h ising p ices o basic goods, exace ba ed po e y le els, pa icula ly in u ban slums and u al
a eas. Food insecu i y became a g owing issue as people s uggled o mee hei basic needs. The go e nmen and non-
go e nmen al o ganiza ions (NGOs) made e o s o p o ide ood assis ance, bu he scale o he p oblem was oo la ge
o hese ini ia i es o ully add ess he widesp ead economic su e ing.
The pandemic also in ensi ied he men al heal h c isis in Bangladesh. The ea o con ac ing he i us, combined wi h
he loss o lo ed ones, economic s ain, and isola ion due o lockdowns, con ibu ed o ising le els o s ess, anxie y,
and dep ession. Men al heal h se ices, which we e al eady unde de eloped, became e en mo e inaccessible due o
es ic ions on mo emen and he o e whelming demands on heal hca e p o ide s. This le many people coping wi h
men al heal h issues in silence, u he s aining he social ab ic o he coun y.
Mo eo e , he pandemic highligh ed he deep-sea ed inequali ies in he heal hca e sys em. Ru al a eas, whe e
heal hca e access was al eady limi ed, we e hi especially ha d as people s uggled o access e en basic medical se ices.
The u ban- u al di ide in heal hca e acili ies became mo e p onounced, wi h people in emo e a eas ha ing o a el
long dis ances o access hospi als o clinics, o en wi h li le success due o o e c owding and lack o esou ces. In he
ci ies, while heal hca e acili ies we e ela i ely be e equipped, he su ge in cases led o sho ages in c i ical ca e
se ices, such as ICU beds and oxygen supply, o cing hospi als o make di icul decisions abou who would ecei e li e-
sa ing ea men .
The o e all heal h c isis was u he exace ba ed by misin o ma ion and a lack o public heal h awa eness. In he
absence o clea and accu a e in o ma ion, umo s and conspi acy heo ies sp ead, which unde mined e o s o cu b
he i us. Many people we e hesi an o seek medical help due o ea o being s igma ized o being u ned away om
hospi als. Some e en esis ed public heal h measu es such as wea ing masks o social dis ancing, u he complica ing
he igh agains he pandemic.
6. Implica ions in Heal hca e Sys em o a De eloping Na ion
The COVID-19 pandemic has s a kly exposed he ulne abili ies o heal hca e sys ems in de eloping na ions, as
illus a ed by he case o Bangladesh. The coun y's dea h- o-case a io o 1.44%, which exceeds he global a e age o
