Ecological Study on Differences in COVID-19 Fatality among Wuhan, Rest of Hubei, and Rest of China

Background: China’s vigorous anti-COVID-19 campaign has been going on for three months since January 20, which has contained the spread of the virus across China. Objectives: Epidemiological investigations found that COVID-19 fatality rates in Wuhan, rest parts of Hubei province except Wuhan (Rest of Hubei) and rest parts of Mainland China except Hubei province (Rest of China) were different. An ecological study was conducted to analyze the reasons and provide the world with China’s anti-COVID-19 epidemic experiences. Methods: Infected cases from Mainland China were divided into three populations: Wuhan, Rest of Hubei and Rest of China. Methods were based on The Novel Coronavirus Infected Pneumonia Diagnosis and Treatment Standards. Total confirmed cases, daily severe cases, total deaths from February 12 to April 20 were collected for statistical analysis. Results: 50,333 total confirmed cases in Wuhan made up the most substantial part by comparison with 17,795 in Rest of Hubei and 14,630 in Rest of China, respectively. In the early stage of the COVID-19 epidemic, daily severe cases in Wuhan accounted for the majority, and as the epidemic controlled, severe cases in all three populations decreased. Total deaths in Wuhan constituted the most significant proportion, with the highest 3869 in contrast to 643 in Rest of Hubei and 120 in Rest of China. The fatality rates in Wuhan ranged from 2.82% to 7.69%, much higher than 1.80–3.61% in Rest of Hubei, and 0.49–0.88% in Rest of China. Pearson chi-square test for fatality rates in the three populations demonstrated significant differences (p < 0.01). Conclusion: The ecological comparison study among the three populations have proved that social distancing, quarantine, lockdown, cutting off sources of infection and transmission routes, early detection, early isolation, early treatment are all vital to control the epidemic by reducing COVID-19 confirmed cases, severe cases and the fatality rate.