Does the United States have the lowest fatality rate in the world, as Donald Trump claims?

During his first public speech since the election, Donald Trump defended his management of the epidemic. The United States, he assures, has the lowest case fatality rate in the world: a false claim about an indicator of little relevance in the current period.

Still refusing to admit the victory of Joe Biden, Donald Trump spoke for the first time on Friday since the announcement of the results of the presidential election. A press conference lasting just over half an hour during which he focused on the management of the Covid-19 epidemic and on the recent advances announced by Pfizer in the design of a vaccine.

Donald Trump, during his speech, praised the successes he attributes to his administration: "Our country has the lowest fatality rate in the world," he did not hesitate to say. Comments denied by the figures.

    An indicator to be taken with enormous tweezers

To verify the statements of the American president, we can look at the data compiled by Johns-Hopkins University, a reference source mobilized since the start of the epidemic. If the latter aggregates figures relating to the number of cases or deaths across the world, it is also interested in the case fatality rate. A rate that reflects the proportion of disease-related deaths in relation to the total number of cases identified.

With 10.5 million recorded cases and just over 242,000 deaths, the United States today has a case fatality rate of 2.3%. This is less than Great Britain (3.9%) or Italy (4.1%), but more than Germany (1.6%) or France (2.2%). In fact, according to Johns Hopkins University, no less than 107 countries have a lower case fatality rate than the United States.

If Donald Trump's words turn out to be completely false, it is necessary to emphasize that in the context of a pandemic such as the one we are currently experiencing, the case fatality rate is an unhelpful, even misleading indicator. Indeed, since it is based on the number of deaths compared to the number of cases detected, it turns out to be very dependent on the screening policies implemented by the various countries.

If a country decides to test only a tiny portion of its population but records multiple deaths, the case fatality rate will jump. Conversely, a country that multiplies the tests will mathematically see a drop in the case fatality rate on its soil. As Liberation demonstrated in June, France has long had a very high case fatality rate, due to a lack of screening capacity. A situation which is no longer relevant today.

Other, more relevant indicators are more judicious to compare the impact of the epidemic according to country: the number of deaths per 100,000 inhabitants in particular. With 74 deaths per 100,000 inhabitants, the United States thus posts the 13th worst record in the world, even the 11th if we disregard San Marino and Andorra, whose very small population makes the data more fragile.

Not very relevant, the case fatality rate advanced by Donald Trump must therefore be analyzed with great caution. We must also be careful not to confuse it with the real fatality rate, or "infection fatality rate" in its English version, which the researchers are looking at. The latter in fact designates the proportion of people affected by the virus and who die from it. This indicator, which is difficult to assess because it supposes knowing precisely the share of the contaminated population, is the subject of models by scientists. As LCI indicated a few days ago, it is estimated today at around 1%, with disparities depending on the country and especially the age groups.

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