# **1. Introduction**

Views about the severity of the coronavirus (COVID-19) pandemic have evolved considerably since the outbreak in Wuhan, China. While initially thought to remain confined to China, the virus spread soon afterwards to the rest of the region and the world. In a matter of a few weeks, more than 5.5 million people in 213 countries and territories became infected (Worldometer, 2020). A local outbreak became a full-scale pandemic, entire countries were locked down and the world collectively came to face the prospect of the worst economic downturn since the Great Depression (IMF, 2020).

Despite the rapid and extensive spread of the virus, the reported death toll remains surprisingly concentrated in just a few geographies. As of May 23—the cut-off point for this paper—the global death toll amounted to some 340,000 people. The vast majority of the fatalities reported thus far is in the high-income countries (HICs). Just five of them are responsible for 65 percent of the global total. Together, the HICs represent 79 percent of all deaths.

That leaves 21 percent to the developing world, which is nevertheless much more populous. Upper-middle income countries (UMICs) claim 18 percent of the global total toll, but their share in the global population is just over a third. The contrast is even starker for the poorer developing countries. Lower-middle income countries (LMICs) and low-income countries (LICs) claim just 3 percent of the death toll; yet they represent almost half of the world’s population.

The unequal distribution of the impact of the pandemic in favor of the developing world is highly unusual and has the appearance of the world dealing two different pandemics, with the metaphor alluding to the differential impact. As recently noted by Cash and Patel (2020), “for the first time in the post-war history of epidemics, there is a reversal of which countries are most heavily affected by a disease pandemic.” Some have conjectured that this feature of inequality is here to stay: indeed, “the low Covid-19 death toll raises hopes Africa may be spared the worst” (Pilling, 2020).

Against this backdrop, the paper attempts to shed light on three interrelated questions:

- How unequally severe has the pandemic been so far across countries and over time?

- What explains the observed contrast between rich and poor countries?

- What does the future hold for the developing world?

The first part of the paper documents the unequal distribution and progression of the COVID-19 mortality burden across countries through the lens of a new indicator of ‘relative severity.’ This indicator expresses the severity of the mortality toll relative to pre-pandemic patterns, both in terms of all-cause mortality and the top causes of death specific to individual countries. This part of the analysis will bring out the sheer inequality in the mortality toll at the individual country level.

The second part questions the observed inequality between rich and poor countries. It conducts a thought experiment which suggests that the low developing-country share in total deaths is entirely unexpected. Its first step is to simulate the distribution of COVID-19 mortality across World Bank income classifications by applying a reasonable range of epidemiological patterns of infectivity and fatality to the world’s age distributions. The second step is to consider how relative to this baseline host-specific factors other than age (e.g. comorbidities) and environmental factors (e.g. temperature, density, healthy systems, distancing policies) are likely to affect the baseline.

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