Statistical biases and decision-making at the healthcare system level

Statistical biases have affected medical decision-making during the COVID-19 pandemic. Accordingly, some issues need to be considered when reporting statistics of COVID-19 at the country level and the state level. First, given the unequal distribution of population within the country, the use of aggregated data from country-level to calculate the state or national statistics might result in the biased overall estimated COVID-19 growth rate due to the higher spread rate and number of death in hotspot regions 6. Second, the population of each country must be considered when the number of infected patients is reported. As the population of a country increases, the number of infected cases is expected to potentially increase, and this is an issue needed to be considered in determining the severity of countries’ states7. Third, the number of performed COVID-19 tests is a crucial factor to be considered when comparing the condition of countries in terms of the number of confirmed cases. As the number of performed cases in a country increases, the number of diagnosed asymptomatic cases increases, and this results in a high disease rate report for that country. Indeed, this country is prosperous in detecting a large percentage of both symptomatic and asymptomatic cases and isolates them to cease the infection spread, while the reported rate can add biases that the mentioned country has failed in disease control.