Estimates and Determinants of SARS-Cov-2 Seroprevalence and Infection Fatality Ratio Using Latent Class Analysis: The Population-Based Tirschenreuth Study in the Hardest-Hit German County in Spring 2020
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Abstract
SARS-CoV-2 infection fatality ratios (IFR) remain controversially discussed with implications for political measures. The German county of Tirschenreuth suffered a severe SARS-CoV-2 outbreak in spring 2020, with particularly high case fatality ratio (CFR). To estimate seroprevalence, underreported infections, and IFR for the Tirschenreuth population aged ≥14 years in June/July 2020, we conducted a population-based study including home visits for the elderly, and analyzed 4203 participants for SARS-CoV-2 antibodies via three antibody tests. Latent class analysis yielded 8.6% standardized county-wide seroprevalence, a factor of underreported infections of 5.0, and 2.5% overall IFR. Seroprevalence was two-fold higher among medical workers and one third among current smokers with similar proportions of registered infections. While seroprevalence did not show an age-trend, the factor of underreported infections was 12.2 in the young versus 1.7 for ≥85-year-old. Age-specific IFRs were <0.5% below 60 years of age, 1.0% for age 60–69, and 13.2% for age 70+. Senior care homes accounted for 45% of COVID-19-related deaths, reflected by an IFR of 7.5% among individuals aged 70+ and an overall IFR of 1.4% when excluding senior care home residents from our computation. Our data underscore senior care home infections as key determinant of IFR additionally to age, insufficient targeted testing in the young, and the need for further investigations on behavioral or molecular causes of the fewer infections among current smokers.
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SciScore for 10.1101/2021.03.29.21254343: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The TiKoCo study was approved by the Ethics Committee of the University of Regensburg, Germany (vote 12-101-0258) and adopted by the Ethics Committee of the University of Erlangen (vote 248_20 Bc).
Consent: All participants provided written informed consent.Randomization This suggested that up to 7 200 randomly sampled individuals were to be contacted to successfully recruit the calculated 3 600 baseline study participants. Blinding not detected. Power Analysis With regard to a future longitudinal survey, also changes in seroprevalence between two sampling time points of 0.1% could be proven statistically significant at a predefined statistical power of 80%. Sex … SciScore for 10.1101/2021.03.29.21254343: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The TiKoCo study was approved by the Ethics Committee of the University of Regensburg, Germany (vote 12-101-0258) and adopted by the Ethics Committee of the University of Erlangen (vote 248_20 Bc).
Consent: All participants provided written informed consent.Randomization This suggested that up to 7 200 randomly sampled individuals were to be contacted to successfully recruit the calculated 3 600 baseline study participants. Blinding not detected. Power Analysis With regard to a future longitudinal survey, also changes in seroprevalence between two sampling time points of 0.1% could be proven statistically significant at a predefined statistical power of 80%. Sex as a biological variable Based on data on county residents regarding sex and age, which were available for each municipality (Bayerisches Landesamt für Statistik 2019), we determined, for each of the 26 municipalities, the number of men and women, which corresponded to the share of the members of the municipality within the total population of the county Tirschenreuth, respectively. Table 2: Resources
Antibodies Sentences Resources The Elecsys Anti-SARS-CoV-2 test (Roche Diagnostics GmbH, Penzberg, Germany) detecting nucleoprotein- (N)-directed complete Ig was operated on the Cobas pro e 801 module and the YHLO SARS CoV-2 test (Shenzhen Yhlo Biotech Co., Ltd., Shenzen, China) detects IgG antibodies to the N- and S-protein on the iFlash 1800 according to the manufacturers recommendations, respectively. Anti-SARS-CoV-2suggested: Nonedetects IgGsuggested: NoneA validated in-house ELISA detecting IgG antibody responses to the receptor binding domain (RBD) of the SARS-CoV-2 spike protein was performed essentially as described earlier [13] ELISA detecting IgGsuggested: NoneSoftware and Algorithms Sentences Resources The statistical software SAS version 9.4 (SAS Institute Inc. SAS Institutesuggested: (Statistical Analysis System, RRID:SCR_008567)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: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).
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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