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SARS-CoV-2 infection fatality risk in a nationwide seroepidemiological study
Roberto Pastor-Barriuso; Beatriz Perez-Gomez; Miguel A Hernan; Mayte Perez-Olmeda; Raquel Yotti; Jesus Oteo; Jose Luis Sanmartin; Inmaculada Leon-Gomez; Aurora Fernandez-Garcia; Pablo Fernandez-Navarro; Israel Cruz; Mariano Martin; Concepcion Delgado-Sanz; Nerea Fernandez de Larrea; Jose Leon Paniagua; Juan Fernando Munoz-Montalvo; Faustino Blanco; Amparo Larrauri; Marina Pollan; Marina Pollan.
Affiliation
  • Roberto Pastor-Barriuso; Instituto de Salud Carlos III
  • Beatriz Perez-Gomez; Instituto de Salud Carlos III
  • Miguel A Hernan; Chan School of Public Health, Harvard
  • Mayte Perez-Olmeda; Instituto de Salud Carlos III
  • Raquel Yotti; Instituto de Salud Carlos III
  • Jesus Oteo; Instituto de Salud Carlos III
  • Jose Luis Sanmartin; Ministerio de Sanidad
  • Inmaculada Leon-Gomez; Instituto de Salud Carlos III
  • Aurora Fernandez-Garcia; Instituto de Salud Carlos III
  • Pablo Fernandez-Navarro; Instituto de Salud Carlos III
  • Israel Cruz; Instituto de Salud Carlos III
  • Mariano Martin; Ministerio de Sanidad
  • Concepcion Delgado-Sanz; Instituto de Salud Carlos III
  • Nerea Fernandez de Larrea; Instituto de Salud Carlos III
  • Jose Leon Paniagua; Instituto de Salud Carlos III
  • Juan Fernando Munoz-Montalvo; Ministerio de Sanidad
  • Faustino Blanco; Ministerio de Sanidad
  • Amparo Larrauri; Instituto de Salud Carlos III
  • Marina Pollan; Instituto de Salud Carlos III
  • Marina Pollan; Instituto de Salud Carlos III
Preprint in English | medRxiv | ID: ppmedrxiv-20169722
ABSTRACT
ObjectiveTo estimate the range of the age- and sex-specific infection fatality risk (IFR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on confirmed coronavirus disease 2019 (COVID-19) deaths and excess all-cause deaths. DesignNationwide population-based seroepidemiological study combined with two national surveillance systems. Setting and participantsNon-institutionalized Spanish population of all ages. Main outcome measuresThe range of IFR was calculated as the observed number of COVID-19 deaths and excess deaths divided by the estimated number of SARS-CoV-2 infections in the non-institutionalized Spanish population. Laboratory-confirmed COVID-19 deaths were obtained from the National Epidemiological Surveillance Network (RENAVE) and excess all-cause deaths from the Monitoring Mortality System (MoMo) up to July 15, 2020. SARS-CoV-2 infections were derived from the estimated seroprevalence by a chemiluminiscent microparticle immunoassay for IgG antibodies in 61,092 participants in the ENE-COVID nationwide serosurvey between April 27 and June 22, 2020. ResultsThe overall IFR (95% confidence interval) was 0.8% (0.8% to 0.9%) for confirmed COVID-19 deaths and 1.1% (1.0% to 1.2%) for excess deaths. The IFR ranged between 1.1% (1.0% to 1.2%) and 1.4% (1.3% to 1.5%) in men and between 0.6% (0.5% to 0.6%) and 0.8% (0.7% to 0.8%) in women. The IFR increased sharply after age 50, ranging between 11.6% (8.1% to 16.5%) and 16.4% (11.4% to 23.2%) in men [≥]80 years and between 4.6% (3.4% to 6.3%) and 6.5% (4.7% to 8.8%) in women [≥]80 years. ConclusionThe sharp increase in SARS-CoV-2 IFR after age 50 was more marked in men than in women. Fatality from COVID-19 is substantially greater than that reported for other common respiratory diseases such as seasonal influenza. WHAT IS ALREADY KNOWN ON THIS TOPICInfection fatality risk (IFR) for SARS-CoV-2 is a key indicator for policy decision making, but its magnitude remains under debate. Case fatality risk, which accounts for deaths among confirmed COVID-19 cases, overestimates SARS-CoV-2 fatality as it excludes a large proportion of asymptomatic and mild-symptomatic infections. Population-based seroepidemiological studies are a valuable tool to properly estimate the number of infected individuals, regardless of symptoms. Also, because ascertainment of deaths due to COVID-19 is often incomplete, the calculation of the IFR should be complemented with data on excess all-cause mortality. In addition, data on age- and sex-specific IFR are scarce, even though age and sex are well known modifiers of the clinical evolution of COVID-19. WHAT THIS STUDY ADDSUsing the ENE-COVID nationwide serosurvey and two national surveillance systems in Spain, this study provides a range of age- and sex-specific IFR estimates for SARS-CoV-2 based on laboratory-confirmed COVID-19 deaths and excess all-cause deaths. The risk of death was very low among infected individuals younger than 50 years, but it increased sharply with age, particularly among men. In the oldest age group ([≥]80 years), it was estimated that 12% to 16% of infected men and 5% to 6% of infected women died during the first epidemic wave.
License
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Full text: Available Collection: Preprints Database: medRxiv Type of study: Observational study / Prognostic study Language: English Year: 2020 Document type: Preprint
Full text: Available Collection: Preprints Database: medRxiv Type of study: Observational study / Prognostic study Language: English Year: 2020 Document type: Preprint
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