What's the best way to estimate and track COVID-19 mortality?

July 28, 2020

When used correctly, the symptomatic case fatality ratio (sCFR) and the infection fatality ratio (IFR) are better measures by which to monitor COVID-19 epidemics than the commonly reported case fatality ratio (CFR), according to a new study published this week in PLOS Medicine by Anthony Hauser of the University of Bern, Switzerland, and colleagues.

Reliable estimates of the mortality from SARS-CoV-2 infection are essential to understand the COVID-19 epidemic and develop public health interventions. However, the commonly used CFR--the number of reported deaths divided by the number of reported cases--can be a misleading measure of mortality associated with COVID-19. In the new study, researchers developed a computational model of the dynamics of transmission of SARS-CoV-2 along with COVID-19 associated mortality. The model took into account the delay between infection and death, the increased diagnosis of disease in people with severe symptoms, and stratified data by age.

The researchers applied the model to Hubei province (China), Austria, Bavaria (Germany), Baden- Württemberg (Germany), Lombardy (Italy), Spain and Switzerland. In Hubei, the calculated IFR was 2.9% (95% credible interval [CrI] 2.4-3.5) while the CFR was 2.4%. In Europe, estimates of the IFR ranged from 0.5 (95% CrI 0.4-0.6) to 1.4% (95% CrI: 1.1-1.6) while the CFR ranged from 3.9% to 17.8%. Overall, estimates of sCFR and IFR were similar to each other and varied less geographically than the CFR.

"The CFR is not a good predictor of overall mortality from SARS-CoV-2 and should not be used for evaluation of policy or comparison across settings," the authors say. "The sCFR and IFR, adjusted for [the right biases], are measures that can be used to improve and monitor clinical and public health strategies to reduce the deaths from SARS-CoV-2 infection."
-end-
Research Article

Press-Only Preview of the Article: https://plos.io/32HLODF

In your coverage please use this URL to provide access to the freely available paper:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003189

Funding: JR is funded by the Swiss National Science Foundation (grant 174281). MJC is funded by the Swiss National Science Foundation (grant 176233). This project has received funding from the European Union's Horizon 2020 research and innovation programme - project EpiPose (No 101003688). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: NL is a member of the editorial board of PLOS Medicine.

Citation: Hauser A, Counotte MJ, Margossian CC, Konstantinoudis G, Low N, Althaus CL, et al. (2020) Estimation of SARS-CoV-2 mortality during the early stages of an epidemic: A modeling study in Hubei, China, and six regions in Europe. PLoS Med 17(7): e1003189. https://doi.org/10.1371/journal.pmed.1003189

Contact: Julien Riou, julien.riou@ispm.unibe.ch

Author Affiliations: Anthony Hauser: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

Michel J. Counotte: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

Charles C. Margossian: Department of Statistics, Columbia University, New York, New York, United States of America

Garyfallos Konstantinoudis: MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom

Nicola Low: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

Christian L. Althaus: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

Julien Riou: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland, Division of infectious diseases, Federal Office of Public Health, Bern, Switzerland

PLOS

Related Mortality Articles from Brightsurf:

Being in treatment with statins reduces COVID-19 mortality by 22% to 25%
A research by the Universitat Rovira i Virgili (URV) and Pere Virgili Institut (IISPV) led by LluĂ­s Masana has found that people who are being treated with statins have a 22% to 25% lower risk of dying from COVID-19.

Mortality rate higher for US rural residents
A recent study by Syracuse University sociology professor Shannon Monnat shows that mortality rates are higher for U.S. working-age residents who live in rural areas instead of metro areas, and the gap is getting wider.

COVID-19, excess all-cause mortality in US, 18 comparison countries
COVID-19 deaths and excess all-cause mortality in the U.S. are compared with 18 countries with diverse COVID-19 responses in this study.

New analysis shows hydroxychloroquine does not lower mortality in COVID-19 patients, and is associated with increased mortality when combined with the antibiotic azithromycin
A new meta-analysis of published studies into the drug hydroxychloroquine shows that it does not lower mortality in COVID-19 patients, and using it combined with the antibiotic azithromycin is associated with a 27% increased mortality.

Hydroxychloroquine reduces in-hospital COVID-19 mortality
An Italian observational study contributes to the ongoing debate regarding the use of hydroxychloroquine in the current pandemic.

What's the best way to estimate and track COVID-19 mortality?
When used correctly, the symptomatic case fatality ratio (sCFR) and the infection fatality ratio (IFR) are better measures by which to monitor COVID-19 epidemics than the commonly reported case fatality ratio (CFR), according to a new study published this week in PLOS Medicine by Anthony Hauser of the University of Bern, Switzerland, and colleagues.

COVID-19: Bacteriophage could decrease mortality
Bacteriophage can reduce bacterial growth in the lungs, limiting fluid build-up.

COPD and smoking associated with higher COVID-19 mortality
Current smokers and people with chronic obstructive pulmonary disease (COPD) have an increased risk of severe complications and higher mortality with COVID-19 infection, according to a new study published May 11, 2020 in the open-access journal PLOS ONE by Jaber Alqahtani of University College London, UK, and colleagues.

Highest mortality risks for poor and unemployed
Large dataset shows that income, work status and education have a clear influence on mortality in Germany.

Addressing causes of mortality in Zambia
Despite the fact that people in sub-Saharan Africa are now living longer than they did two decades ago, their average life expectancy remains below that of the rest of the world population.

Read More: Mortality News and Mortality Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.