A scaling approach to estimate the COVID-19 infection fatality ratio from incomplete data

TL;DR

This paper introduces a scaling method leveraging age-related mortality growth and antibody data to estimate COVID-19 infection fatality ratios across countries, revealing significant underreporting and demographic effects.

Contribution

It develops a novel approach combining universal age-mortality patterns with seroprevalence data to accurately estimate infection fatality ratios and quantify underreported deaths.

Findings

Infection fatality ratio (IFR) varies significantly with age.

Official death counts underestimate COVID-19 mortality, especially in older populations.

The IFR ranges from 0.14% in middle Africa to 1.82% in Italy.

Abstract

SARS-CoV-2 has disrupted the life of billions of people around the world since the first outbreak was officially declared in China at the beginning of 2020. Yet, important questions such as how deadly it is or its degree of spread within different countries remain unanswered. In this work, we exploit the `universal' growth of the mortality rate with age observed in different countries since the beginning of their respective outbreaks, combined with the results of the antibody prevalence tests in the population of Spain, to unveil both unknowns. We validate these results with an analogous antibody rate survey in the canton of Geneva, Switzerland. We also argue that the official number of deaths over 70 years old is importantly underestimated in most of the countries, and we use the comparison between the official records with the number of deaths mentioning COVID-19 in the death certificates to quantify by how much. Using this information, we estimate the fatality infection ratio (IFR) for the different age segments and the fraction of the population infected in different countries assuming a uniform exposure to the virus in all age segments. We also give estimations for the non-uniform IFR using the sero-epidemiological results of Spain, showing a very similar growth of the fatality ratio with age. Only for Spain, we estimate the probability (if infected) of being identified as a case, being hospitalized or admitted in the intensive care units as function of age. In general, we observe a nearly exponential growth of the fatality ratio with age, which anticipates large differences in total IFR in countries with different demographic distributions, with numbers that range from 1.82\% in Italy, to 0.62\% in China or even 0.14\% in middle Africa.