COVID-19 case fatality risk by age and gender in a high testing setting in Latin America: Chile, March–August 2020

  1. Eduardo A. Undurraga
  2. Gerardo Chowell
  3. Kenji Mizumoto

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Abstract

Background

Early severity estimates of coronavirus disease 2019 (COVID-19) are critically needed to assess the potential impact of the ongoing pandemic in different demographic groups. Here we estimate the real-time delay-adjusted case fatality rate across nine age groups by gender in Chile, the country with the highest testing rate for COVID-19 in Latin America.

Methods

We used a publicly available real-time daily series of age-stratified COVID-19 cases and deaths reported by the Ministry of Health in Chile from the beginning of the epidemic in March through August 31, 2020. We used a robust likelihood function and a delay distribution to estimate real-time delay-adjusted case-fatality risk and estimate model parameters using a Monte Carlo Markov Chain in a Bayesian framework.

Results

As of August 31, 2020, our estimates of the time-delay adjusted case fatality rate (CFR) for men and women are 4.16% [95% Credible Interval (CrI): 4.09–4.24%] and 3.26% (95% CrI: 3.19–3.34%), respectively, while the overall estimate is 3.72% (95% CrI: 3.67–3.78%). Seniors aged 80 years and over have an adjusted CFR of 56.82% (95% CrI: 55.25–58.34%) for men and 41.10% (95% CrI: 40.02–42.26%) for women. Results showed a peak in estimated CFR during the June peak of the epidemic. The peak possibly reflects insufficient laboratory capacity, as illustrated by high test positivity rates (33% positive 7-day average nationally in June), which may have resulted in lower reporting rates.

Conclusions

Severity estimates from COVID-19 in Chile suggest that male seniors, especially among those aged ≥ 70 years, are being disproportionately affected by the pandemic, a finding consistent with other regions. The ongoing pandemic is imposing a high death toll in South America, and Chile has one of the highest reported mortality rates globally thus far. These real-time estimates may help inform public health officials' decisions in the region and underscore the need to implement more effective measures to ameliorate fatality.

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  1. Version published to 10.1186/s40249-020-00785-1
  2. ScreenIT

    SciScore for 10.1101/2020.05.25.20112904: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results 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:
    Our study is not exempted from limitations. Our CFR estimates are probably affected by under ascertainment, as has been estimated elsewhere [24-28], which may have pushed our estimates upwards. Infectious disease with a substantial share of asymptomatic or mild infections, such as COVID-19, may be more accurately characterized by infection-fatality risk (deaths / infected people), but those data are not yet available in Chile. In conclusion, using real-time epidemiological data from a high COVID-19 testing setting in Latin America, we found that COVID-19 epidemic in Chile disproportionately affected seniors, especially those aged ≥ 70 years, suggesting an older population could exacerbate the death toll brought by COVID-19. COVID-19 is already imposing a high death toll in Latin America. Case fatality rates in Chile suggest the health system is not yet overwhelmed, but the epidemic is expanding fast, and healthcare demand may soon exceed capacity. These real-time estimates may help inform decisions by public health officials in the region, and underscore the need for continuous efforts to face this pandemic.

    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.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.05.25.20112904v1 on medRxiv