key: cord-0723274-d9nk3f79 authors: Azizi, Hosein; Esmaeili, Elham Davtalab; Fakhari, Ali title: Challenges and accurate estimates of the Mortality and Case Fatality Rates by COVID-19 date: 2020-10-08 journal: New Microbes New Infect DOI: 10.1016/j.nmni.2020.100775 sha: 28e5fe2f0ca1b5e2f5593b4269f49d0e6cdd16c9 doc_id: 723274 cord_uid: d9nk3f79 Many reasons restrict obtaining an accurate estimate of Case Fatality Rate (CFR) and Mortality Rate (MR) by COVID-19. The main concern is the number of infected people and deaths. We aimed to discuss some solutions for accurate estimating of CFR and MR. stigma, and un-accurate statistics leading to underestimation or overestimation of the outcome measures of disease (CFR and MR). The underestimation or overestimation of CFR has direct effects on MR by COVID-19 [3] . The bellow solutions are recommended for accurate estimating of CFR and MR in COVID-19. 1) Excess Death Estimation; the comparison of vital records and statistics of all the current deaths with the previous months and years at the same time as free of COVID-19 can able to obtain an accurate number of deaths by COVID-19. 2) Developing a dynamic and efficient surveillance system. A strong surveillance system in addition to covering many aspects of disease surveillance including contact tracing, rapid disease detection and screening, principles of appropriate outbreak management at the local level, infectivity and secondary attacks rates of virus, pre-hospital and hospital cares, quarantine and isolation, border and airport care, and telemedicine can also cover other aspects of disease care and prevention such as report and reporting process, knowledge transfer, reporting in a suitable format for decision-makers to assess accurate outcome measures [4] . 3) Assessment measures and indicators should be defined for calculating the validity, capacity, and reliability of COVID-19 surveillance system. Sensitivity, specificity, positive, and negative predictive value are important measures. However, due to the low sensitivity of COVID-19 diagnostic tests and the high false-negative percentage, and the long interval between the initial diagnosis and the laboratory confirmed, reliability indicators such as Percent Positive Agreement (PPA) and KAPPA statistics are recommended. 4) Phone and electronic screening by reporting probable signs and symptoms from the general population and at-risk people to identify suspected cases after laboratory-confirmed can able to increase the number of infected patients (denominator of CFR) [5] . 5) Educating health care providers who issue death certificates, to obtain accurate statistics especially for comorbidities cases where a COVID-19 patient has another disease. The many estimates of the COVID-19 case fatality rate. The Lancet Infectious Diseases Case fatality rate of coronavirus disease 2019 (COVID-19) in Iran-a term of caution Coronavirus: covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate Davtalab-Esmaeili E: Structure, Characteristics and Components of COVID-19 Surveillance System Iranian First-Line Health Care Providers Practice in COVID-19 Outbreak We declare no competing interests.