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Reviews of "The infection fatality rate of COVID-19 inferred from seroprevalence data"

Reviewers: Timothy Hallett (Imperial College London) | 📒📒📒 ◻️◻️ • Kenji Mizumoto (Kyoto University), Gerardo Chowell (Georgia State University) | 📒📒📒 ◻️ ◻️ • Abraham D. Flaxman (University of Washington) | 📕 ◻️◻️◻️◻️

Published onAug 23, 2020
Reviews of "The infection fatality rate of COVID-19 inferred from seroprevalence data"
key-enterThis Pub is a Review of
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 July 11, 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. Secondarily, results from national studies were also examined from preliminary press releases and reports whenever a country had no other data presented in full papers of preprints. Results 36 studies (43 estimates) were identified with usable data to enter into calculations and another 7 preliminary national estimates were also considered for a total of 50 estimates. Seroprevalence estimates ranged from 0.222% to 47%. Infection fatality rates ranged from 0.00% to 1.63% and corrected values ranged from 0.00% to 1.31%. Across 32 different locations, the median infection fatality rate was 0.27% (corrected 0.24%). Most studies were done in pandemic epicenters with high death tolls. Median corrected IFR was 0.10% in locations with COVID-19 population mortality rate less than the global average (<73 deaths per million as of July 12, 2020), 0.27% in locations with 73-500 COVID-19 deaths per million, and 0.90% in locations exceeding 500 COVID-19 deaths per million. Among people <70 years old, infection fatality rates ranged from 0.00% to 0.57% with median of 0.05% across the different locations (corrected median of 0.04%). 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.

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Summary of Reviews: This study finds substantial heterogeneity in the infection fatality rate across different locations. Data are useful and add to the emerging picture on IFR, however, substantial conclusions cannot be drawn.

Reviewer 1 (Timothy Hallett) | 📒📒📒 ◻️◻️

Reviewer 2 (Kenji Mizumoto, Gerardo Chowell) | 📒📒📒 ◻️◻️

Reviewer 3 (Abraham D. Flaxman) | 📕 ◻️◻️◻️◻️

RR:C19 Strength of Evidence Scale Key

📕 ◻️◻️◻️◻️ = Misleading

📙📙 ◻️◻️◻️ = Not Informative

📒📒📒 ◻️◻️ = Potentially Informative

📗📗📗📗◻️ = Reliable

📘📘📘📘📘 = Strong

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