Infection fatality risk for SARS-CoV-2 in community dwelling population of Spain: nationwide seroepidemiological study
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Abstract
Objective
To estimate the infection fatality risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), based on deaths with confirmed coronavirus disease 2019 (covid-19) and excess deaths from all causes.
Design
Nationwide seroepidemiological study.
Setting
First wave of covid-19 pandemic in Spain.
Participants
Community dwelling individuals of all ages.
Main outcome measures
The main outcome measure was overall, and age and sex specific, infection fatality risk for SARS-CoV-2 (the number of covid-19 deaths and excess deaths divided by the estimated number of SARS-CoV-2 infections) in the community dwelling Spanish population. Deaths with laboratory confirmed covid-19 were obtained from the National Epidemiological Surveillance Network (RENAVE) and excess all cause deaths from the Monitoring Mortality System (MoMo), up to 15 July 2020. SARS-CoV-2 infections in Spain were derived from the estimated seroprevalence by a chemiluminescent microparticle immunoassay for IgG antibodies in 61 098 participants in the ENE-COVID nationwide seroepidemiological survey between 27 April and 22 June 2020.
Results
The overall infection fatality risk was 0.8% (19 228 of 2.3 million infected individuals, 95% confidence interval 0.8% to 0.9%) for confirmed covid-19 deaths and 1.1% (24 778 of 2.3 million infected individuals, 1.0% to 1.2%) for excess deaths. The infection fatality risk was 1.1% (95% confidence interval 1.0% to 1.2%) to 1.4% (1.3% to 1.5%) in men and 0.6% (0.5% to 0.6%) to 0.8% (0.7% to 0.8%) in women. The infection fatality risk increased sharply after age 50, ranging from 11.6% (8.1% to 16.5%) to 16.4% (11.4% to 23.2%) in men aged 80 or more and from 4.6% (3.4% to 6.3%) to 6.5% (4.7% to 8.8%) in women aged 80 or more.
Conclusion
The increase in SARS-CoV-2 infection fatality risk after age 50 appeared to be more noticeable in men than in women. Based on the results of this study, fatality from covid-19 was greater than that reported for other common respiratory diseases, such as seasonal influenza.
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SciScore for 10.1101/2020.08.06.20169722: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization Estimation of the number of SARS-CoV-2 infections: We calculated the prevalence of IgG antibodies against SARS-CoV-2 in the non-institutionalized Spanish population using data from ENE-COVID, a nationwide population-based serosurvey whose design has been described elsewhere.6 Briefly, 1,500 census tracts, and up to 24 households within each tract, were randomly selected using a two-stage sampling stratified by province and municipality size. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources 7 The study used two immunoassays to detect IgG … SciScore for 10.1101/2020.08.06.20169722: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization Estimation of the number of SARS-CoV-2 infections: We calculated the prevalence of IgG antibodies against SARS-CoV-2 in the non-institutionalized Spanish population using data from ENE-COVID, a nationwide population-based serosurvey whose design has been described elsewhere.6 Briefly, 1,500 census tracts, and up to 24 households within each tract, were randomly selected using a two-stage sampling stratified by province and municipality size. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources 7 The study used two immunoassays to detect IgG antibodies: a point-of-care test (Orient Gene Biotech COVID-19 IgG/IgM Rapid test Cassette), and a chemiluminiscent microparticle immunoassay (CMIA) that required venipuncture (SARS-CoV-2 IgG for use with ARCHITECT; Abbott Laboratories, Abbott Park, IL, USA; reference 06R8620), with better performance characteristics (see supplementary methods and supplementary figure 1 for a summary of reported sensitivity and specificity estimates of the CMIA test). Abbott Laboratoriessuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: We used data from a nation-wide population-based seroepidemiological study and two complementary sources of mortality information—deaths among laboratory-confirmed COVID-19 cases and excess deaths—to estimate the range of IFR, both overall and by age and sex. The ENE-COVID serosurvey was timed to provide an IFR estimate for first wave of SARS-CoV-2 infection in Spain.11 The first round of the study started one month after the peak, which took place around March 20, and the last round ended on June 22. Thus, most participants would have been infected one month before their first participation. As IgG antibodies are detected 2–3 weeks after symptom onset in more than 90% of COVID-19 cases24 and decrease 2–3 months after infection,25 ENE-COVID is expected to cover infections through at least the first week of June. To include potentially delayed COVID-19 deaths, we considered all deaths registered through July 15 (see supplementary figure 2 for the time distribution of COVID-19 cases and deaths in Spain). Also, the test selected to measure antibodies against SARS-CoV-2 had high sensitivity and very high specificity, according to our meta-analysis (see supplementary figure 1). We used its pooled estimates to calculate corrected ENE-COVID seroprevalence figures; the resulting IFR estimates were slightly higher, but consistent with our primary results (see supplementary methods), showing the robustness of our estimators. A limitation of the study is that ...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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- No protocol registration statement was detected.
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