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Publication: Bulletin of the World Health Organization; Type: Research
Article ID: BLT.20.265892
Page 1 of 37
John P A Ioannidis
Infection fatality rate of COVID-19
This online first version has been peer-reviewed, accepted and edited,
but not formatted and finalized with corrections from authors and proofreaders
Infection fatality rate of COVID-19 inferred from
seroprevalence data
John P A Ioannidisa
Meta-Research Innovation Center at Stanford (METRICS), Stanford University, 1265 Welch Road,
Stanford, California 94305, United States of America.
Correspondence to John P A Ioannidis (email: jioannid@stanford.edu).
(Submitted: 13 May 2020 – Revised version received: 13 September 2020 – Accepted: 15 September 2020
– Published online: 14 October 2020)
Objective:
To estimate the infection fatality rate of coronavirus disease 2019 (COVID-19)
from seroprevalence data.
Methods:
I searched PubMed and preprint servers for COVID-19 seroprevalence
studies with a sample size 500 as of 9 September, 2020. I also retrieved additional results
of national studies from preliminary press releases and reports. I assessed the studies for
design features and seroprevalence estimates. I estimated the infection fatality rate for
each study by dividing the number of COVID-19 deaths by the number of people estimated
to be infected in each region. I corrected for the number of antibody types tested
(immunoglobin, IgG, IgM, IgA).
Results:
I included 61 studies (74 estimates) and eight preliminary national
estimates. Seroprevalence estimates ranged from 0.02% to 53.40%. Infection fatality rates
ranged from 0.00% to 1.63%, corrected values from 0.00% to 1.54%. Across 51 locations,
the median COVID-19 infection fatality rate was 0.27% (corrected 0.23%): the rate was
0.09% in locations with COVID-19 population mortality rates less than the global average
(< 118 deaths/million), 0.20% in locations with 118–500 COVID-19 deaths/million people
and 0.57% in locations with > 500 COVID-19 deaths/million people. In people < 70 years,
infection fatality rates ranged from 0.00% to 0.31% with crude and corrected medians of
0.05%.
Conclusion:
The infection fatality rate of COVID-19 can vary substantially across
different locations and this may reflect differences in population age structure and casemix of infected and deceased patients and other factors. The inferred infection fatality rates
tended to be much lower than estimates made earlier in the pandemic.
Study: https://www.who.int/bulletin/online_....20.265892.pdf
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