Chi-Sheng Chang 1,2, Yu-Tsen Yeh 3, Tsair-Wei Chien4, Jui-Chung John Lin5, Bor-Wen Cheng2, Feng-Jie Lai 6,7*

1Center for Quality Management, Chi Mei Medical Center, Liouying,Tainan,Taiwan.

2Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan

3 Medical School, St. George’s University of London, London, United Kingdom

4Research Department, Chi-Mei Medical Center, Tainan, Taiwan

USA Sports Medicine, Sherman oaks, CA,

6Department of Dermatology, Chi-Mei Medical Center, Tainan, Taiwan

7Center for General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan

*Corresponding Author: E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


The study aimed to introduce a new application of the separation index (SI) that allows objective determination of the dominant role in the COVID-19 outbreak which started in the city of Wuhan, China in December 2019 and subsequently spread to other provinces/regions of China as well as the rest of the world. The separation index is capable of determining the dominance, also defined as the absolute advantage (or disadvantage) in a comparable group of measures. We downloaded COVID-19 outbreak data on a daily basis from Google Sheet that provides information on confirmed cases in more than 30 Chinese locations and other countries/regions. Choropleth maps and Kano diagrams were drawn incorporating the 4SQ diagram. Three factors were assessed to determine which region played the most dominant role based on (1) the total number of confirmed cases, (2) the death rate, and (3) the SI of daily increase of confirmed cases using the separation index ranging from 0 to 1.0 (cutting at 0.70). We programmed Microsoft Excel VBA routines to arrange the data. Visual dashboards were created to display the results on Google Maps. 

We observed that as of February 17, 2020, the top three countries/regions within the three respective elements investigated were Hubei (China), Philippines, and British Columbia, with SI of 0.98, 0.61, and 0.52, respectively.

 The separation index is shown useful and capable in identifying the dominant role in a group. Further applications within and outside the context of COVID-19 are worthy of research effort. 

Keywords: COVID-19, separation index, choropleth map, Kano model

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