Early data about the coronavirus disease (Covid-19) suggest that older age is a significant risk factor of mortality, especially if a person has certain pre-existing health conditions. Mortality is likely to be greater among patients who are 60-years-old and older, who account for a significant proportion of Covid-19 deaths.

However, a more thorough comparison of Covid-19 deaths shows disproportionate rates among older age groups by market. GlobalData epidemiologists have compared Covid-19 mortality data by age groups from seven major markets (7MM: US, France, Germany, Italy, Spain, China, South Korea and Singapore).

The analysis found that the proportions of deaths vary by older age groups in each major market. The average proportion of deaths in the 7MM highlights that men and women over the age of 60 years account for the majority of Covid-19 deaths and nearly half of all deaths are among men and women aged 80 years and older. However, Covid-19 deaths in Singapore are only among men and women over the age of 60 years.

For all markets, except China and Singapore, the proportion of deaths increases with older age, with the highest proportion of deaths among the 80 years and older age group. In China, the proportion of deaths among men and women over 80
years account for only 20% of all Covid-19 deaths.

In Singapore, the proportions of deaths among men and women over 60-years-old are equally distributed among the three age groups (60–69 years, 70–79 years and 80 years and older), each accounting for approximately a third of all Covid-19 deaths in the market.

The discrepancy between the proportions in China compared with other markets may be attributed to the limited availability of epidemiological data on Covid-19 in China, including data on age and sex of the deceased. In China, the first reported case of Covid-19 was recorded at the end of December 2019. However, various media outlets have reported that the first case can be traced back to mid-November 2019.

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In mid-February, China changed its case definition to include both laboratory-confirmed cases and clinically confirmed cases, causing a major spike in the number of reported cases. The changes in reporting raised many questions about how deaths from Covid-19 are defined. Do cases that have died with only the clinical definition of Covid-19 count towards the total? Do cases that have died with other comorbid causes such as a heart attack along with Covid-19 infection count towards the total?

It is also not clear how many may have died due to Covid-19 due to the lack of access to testing. Due to the limitations in China, the actual numbers of Covid-19 confirmed cases and deaths are most likely underreported. These concerns are also applicable to other markets, especially in such an early phase of the outbreak where reliable data is limited.

In Singapore, the proportions of deaths among the older age groups are similar to China. However, the actual number of Covid-19 cases and deaths differ drastically. While China currently has over 82,600 confirmed cases, over 3,300 deaths and a case fatality rate (CFR) of approximately 4%, Singapore has only 1,300 cases, six deaths and a CFR of 0.5%. The low CFR in Singapore can be attributed to the country’s early response to the outbreak, including a quick government response and strong epidemiologic surveillance system.

Singapore’s experience with previous infectious disease outbreaks has led the country to develop the ‘Disease Outbreak Response System Condition’ (DORSCON), a colour-coded framework that shows the current disease condition, including the nature of the disease (severity and transmission), impact on daily life and advice to the public. The DORSCON framework also provides general guidelines about actions to take to
prevent and reduce transmission.

Singapore’s preparedness and response highlights the importance that having a strong
epidemiological surveillance system and an organised response to an infectious disease outbreak can make an impact, greatly reducing the transmission and deaths.