Age-specific mortality and immunity patterns of SARS-CoV-2

Megan O’Driscoll (), Gabriel Ribeiro Dos Santos, Lin Wang, Derek A. T. Cummings, Andrew S. Azman, Juliette Paireau, Arnaud Fontanet, Simon Cauchemez () and Henrik Salje ()
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Megan O’Driscoll: University of Cambridge
Gabriel Ribeiro Dos Santos: University of Cambridge
Lin Wang: University of Cambridge
Derek A. T. Cummings: University of Florida
Andrew S. Azman: Johns Hopkins Bloomberg School of Public Health
Juliette Paireau: Institut Pasteur, UMR2000, CNRS
Arnaud Fontanet: Institut Pasteur
Simon Cauchemez: Institut Pasteur, UMR2000, CNRS
Henrik Salje: University of Cambridge

Nature, 2021, vol. 590, issue 7844, 140-145

Abstract: Abstract Estimating the size of the coronavirus disease 2019 (COVID-19) pandemic and the infection severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is made challenging by inconsistencies in the available data. The number of deaths associated with COVID-19 is often used as a key indicator for the size of the epidemic, but the observed number of deaths represents only a minority of all infections1,2. In addition, the heterogeneous burdens in nursing homes and the variable reporting of deaths of older individuals can hinder direct comparisons of mortality rates and the underlying levels of transmission across countries3. Here we use age-specific COVID-19-associated death data from 45 countries and the results of 22 seroprevalence studies to investigate the consistency of infection and fatality patterns across multiple countries. We find that the age distribution of deaths in younger age groups (less than 65 years of age) is very consistent across different settings and demonstrate how these data can provide robust estimates of the share of the population that has been infected. We estimate that the infection fatality ratio is lowest among 5–9-year-old children, with a log-linear increase by age among individuals older than 30 years. Population age structures and heterogeneous burdens in nursing homes explain some but not all of the heterogeneity between countries in infection fatality ratios. Among the 45 countries included in our analysis, we estimate that approximately 5% of these populations had been infected by 1 September 2020, and that much higher transmission rates have probably occurred in a number of Latin American countries. This simple modelling framework can help countries to assess the progression of the pandemic and can be applied in any scenario for which reliable age-specific death data are available.

Date: 2021
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DOI: 10.1038/s41586-020-2918-0

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