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The infection fatality rate of COVID-19 inferred from seroprevalence data |
Objective To estimate the infection fatality rate of coronavirus disease 2019 (COVID-19) from data of seroprevalence studies.
Methods Population studies with sample size of at least 500 and published as peer-reviewed papers or preprints as of June 7, 2020 were retrieved from PubMed, preprint servers, and communications with experts. Studies on blood donors were included, but studies on healthcare workers were excluded. The studies were assessed for design features and seroprevalence estimates. Infection fatality rate was estimated from each study dividing the number of COVID-19 deaths at a relevant time point by the number of estimated people infected in each relevant region. Correction was also attempted accounting for the types of antibodies assessed.
Results 23 studies were identified with usable data to enter into calculations. Seroprevalence estimates ranged from 0.1% to 47%. Infection fatality rates ranged from 0.02% to 0.86% (median 0.26%) and corrected values ranged from 0.02% to 0.78% (median 0.25%). Among people <70 years old, infection fatality rates ranged from 0.00% to 0.26% with median of 0.05% (corrected, 0.00-0.23% with median of 0.04%). Most studies were done in pandemic epicenters and the few studies done in locations with more modest death burden also suggested lower infection fatality rates.
Conclusions The infection fatality rate of COVID-19 can vary substantially across different locations and this may reflect differences in population age structure and case-mix of infected and deceased patients as well as multiple other factors. Estimates of infection fatality rates inferred from seroprevalence studies tend to be much lower than original speculations made in the early days of the pandemic.
### Competing Interest Statement
The authors have declared no competing interest.
### Funding Statement
METRICS has been supported by a grant from the Laura and John Arnold Foundation
### Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
Data from literature; no IRB required
All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
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I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.
Yes
All data are included in the manuscript
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