Age-specific mortality and immunity patterns of SARS-CoV-2 infection in 45 countries

The number of COVID-19 deaths is often used as a key indicator of SARS-CoV-2 epidemic size. 42 However, heterogeneous burdens in nursing homes and variable reporting of deaths in elderly 43 individuals can hamper comparisons of deaths and the number of infections associated with them 44 across countries. Using age-specific death data from 45 countries, we find that relative differences 45 in the number of deaths by age amongst individuals aged <65 years old are highly consistent across 46 locations. Combining these data with data from 15 seroprevalence surveys we demonstrate how 47 age-specific infection fatality ratios (IFRs) can be used to reconstruct infected population 48 proportions. We find notable heterogeneity in overall IFR estimates as suggested by individual 49 serological studies and observe that for most European countries the reported number of deaths 50 amongst [≥]65s are significantly greater than expected, consistent with high infection attack rates 51 experienced by nursing home populations in Europe. Age-specific COVID-19 death data in 52 younger individuals can provide a robust indicator of population immunity.

[1]  S. Leeder,et al.  A population based study , 1993, The Medical journal of Australia.

[2]  Benjamin J Cowling,et al.  The infection attack rate and severity of 2009 pandemic H1N1 influenza in Hong Kong. , 2010, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[3]  Mark Jit,et al.  Projecting social contact matrices in 152 countries using contact surveys and demographic data , 2017, PLoS Comput. Biol..

[4]  J. Lessler,et al.  Estimating the burden of SARS-CoV-2 in France , 2020, Science.

[5]  F. Yu,et al.  Serology characteristics of SARS-CoV-2 infection since exposure and post symptom onset , 2020, European Respiratory Journal.

[6]  Are SARS-CoV-2 seroprevalence estimates biased? , 2020, The Journal of infectious diseases.

[7]  B. Greenhouse,et al.  Are Seroprevalence Estimates for Severe Acute Respiratory Syndrome Coronavirus 2 Biased? , 2020, The Journal of Infectious Diseases.

[8]  N. Hens,et al.  Seroprevalence of IgG antibodies against SARS coronavirus 2 in Belgium: a prospective cross-sectional study of residual samples , 2020, medRxiv.

[9]  M. Poljak,et al.  Low prevalence of active COVID-19 in Slovenia: a nationwide population study of a probability-based sample , 2020, Clinical Microbiology and Infection.

[10]  S. Bhatt,et al.  Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe , 2020, Nature.

[11]  Jens K. Boldsen,et al.  Estimation of SARS-CoV-2 infection fatality rate by real-time antibody screening of blood donors. , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  C. Reusken,et al.  Herd immunity is not a realistic exit strategy during a COVID-19 outbreak , 2020 .

[13]  Jose L. Paniagua,et al.  Infection fatality risk for SARS-CoV-2: a nationwide seroepidemiological study in the non-institutionalized population of Spain , 2020 .

[14]  A. Flahault,et al.  Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study , 2020, The Lancet.

[15]  Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York , 2020, Annals of Epidemiology.

[16]  Bruce Guthrie,et al.  Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study , 2020, The Lancet Global Health.

[17]  C. Whittaker,et al.  Estimates of the severity of coronavirus disease 2019: a model-based analysis , 2020, The Lancet Infectious Diseases.

[18]  Jens K. Boldsen,et al.  Estimation of SARS-CoV-2 Infection Fatality Rate by Real-time Antibody Screening of Blood Donors , 2020, medRxiv.

[19]  P. Klenerman,et al.  Neutralising antibodies to SARS coronavirus 2 in Scottish blood donors - a pilot study of the value of serology to determine population exposure , 2020, medRxiv.

[20]  Jian-min Jin,et al.  Gender Differences in Patients With COVID-19: Focus on Severity and Mortality , 2020, Frontiers in Public Health.

[21]  Mayte Sanmartín Jose L. Pérez-Olmeda A Population-Based Seroepidemiological Study of SARS-CoV-2 in Spain (ENE-COVID) , 2020, Social Science Research Network.

[22]  David R. Holtgrave,et al.  Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York , 2020, Annals of Epidemiology.

[23]  M. Hernán,et al.  Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study , 2020, The Lancet.

[24]  E. Dong,et al.  An interactive web-based dashboard to track COVID-19 in real time , 2020, The Lancet Infectious Diseases.

[25]  S. Bhatt,et al.  Have deaths from COVID-19 in Europe plateaued due to herd immunity? , 2020, The Lancet.

[26]  K. Yuen,et al.  Clinical Characteristics of Coronavirus Disease 2019 in China , 2020, The New England journal of medicine.

[27]  R. Krüger,et al.  Prevalence of SARS-CoV-2 infection in the Luxembourgish population: the CON-VINCE study. , 2020, medRxiv.

[28]  Jose L. Paniagua,et al.  SARS-CoV-2 infection fatality risk in a nationwide seroepidemiological study , 2020, medRxiv.