A Comparison of Case Fatality Risk of COVID-19 between Singapore and Japan

The crude case fatality risk (CFR) for coronavirus disease (COVID-19) in Singapore is remarkably small. We aimed to estimate the unbiased CFR by age for Singapore and Japan and compare these estimates by calculating the standardized mortality ratio (SMR). Age-specific CFRs for COVID-19 were estimated in real time, adjusting for the delay from illness onset to death. The SMR in Japan was estimated by using the age distribution of the Singapore population. Among cases aged 60–69 years and 70–79 years, the age-specific CFRs in Singapore were estimated as 1.84% (95% confidence interval: 0.46–4.72%) and 5.57% (1.41–13.97%), respectively, and those in Japan as 5.52% (4.55–6.62%) and 15.49% (13.81–17.27%), respectively. The SMR of COVID-19 in Japan, when compared with Singapore as the baseline, was estimated to be 1.46 (1.09–2.96). The overall CFR for Singapore is lower than that for Japan. It is possible that the circulating variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Singapore causes a milder clinical course of COVID-19 infection compared with other strains. If infection with a low-virulence SARS-CoV-2 variant provides protection against infection by high-virulence strains, the existence of such a strain is encouraging news for the many countries struggling to suppress this virus.