April 20, 2021

Reconciling estimates of global spread and infection fatality rates of COVID‐19

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/eci.13554

Reconciling estimates of global spread and infection fatality rates of COVID‐19

Reconciling estimates of global spread and infection fatality rates of COVID‐19: an overview of systematic evaluations

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Abstract

Background

Estimates of community spread and infection fatality rate (IFR) of COVID‐19 have varied across studies. Efforts to synthesize the evidence reach seemingly discrepant conclusions.

Methods

Systematic evaluations of seroprevalence studies that had no restrictions based on country and which estimated either total number of people infected and/or aggregate IFRs were identified. Information was extracted and compared on eligibility criteria, searches, amount of evidence included, corrections/adjustments of seroprevalence and death counts, quantitative syntheses and handling of heterogeneity, main estimates, and global representativeness.

Results

Six systematic evaluations were eligible. Each combined data from 10‐338 studies (9‐50 countries), because of different eligibility criteria. Two evaluations had some overt flaws in data, violations of stated eligibility criteria, and biased eligibility criteria (e.g. excluding studies with few deaths) that consistently inflated IFR estimates. Perusal of quantitative synthesis methods also exhibited several challenges and biases. Global representativeness was low with 78‐100% of the evidence coming from Europe or the Americas; the two most problematic evaluations considered only 1 study from other continents. Allowing for these caveats, 4 evaluations largely agreed in their main final estimates for global spread of the pandemic and the other two evaluations would also agree after correcting overt flaws and biases.

Conclusions

All systematic evaluations of seroprevalence data converge that SARS‐CoV‐2 infection is widely spread globally. Acknowledging residual uncertainties, the available evidence suggests average global IFR of ~0.15% and ~1.5‐2.0 billion infections by February 2021 with substantial differences in IFR and in infection spread across continents, countries, and locations.

Source: Wiley online library

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