Estimating the infection-fatality risk of SARS-CoV-2 in New York City during the spring 2020 pandemic wave: a model-based analysis

Abstract

Background As the COVID-19 pandemic continues to unfold, the infection-fatality risk (ie, risk of death among all infected individuals including those with asymptomatic and mild infections) is crucial for gauging the burden of death due to COVID-19 in the coming months or years. Here, we estimate the infection-fatality risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in New York City, NY, USA, the first epidemic centre in the USA, where the infection-fatality risk remains unclear.Methods In this model-based analysis, we developed a meta-population network model-inference system to estimate the underlying SARS-CoV-2 infection rate in New York City during the 2020 spring pandemic wave using available case, mortality, and mobility data. Based on these estimates, we further estimated the infection-fatality risk for all ages overall and for five age groups (<25, 25-44, 45-64, 65-74, and ≥75 years) separately, during the period March 1 to June 6, 2020 (ie, before the city began a phased reopening). FindingsDuring the period March 1 to June 6, 2020, 205 639 people had a laboratory-confirmed infection with SARS-CoV-2 and 21 447 confirmed and probable COVID-19-related deaths occurred among residents of New York City. We estimated an overall infection-fatality risk of 1•39% (95% credible interval 1•04-1•77) in New York City. Our estimated infection-fatality risk for the two oldest age groups (65-74 and ≥75 years) was much higher than the younger age groups, with a cumulative estimated infection-fatality risk of 0•116% (0•0729-0•148) for those aged 25-44 years and 0•939% (0•729-1•19) for those aged 45-64 years versus 4•87% (3•37-6•89) for those aged 65-74 years and 14•2% (10•2-18•1) for those aged 75 years and older. In particular, weekly infection-fatality risk was estimated to be as high as 6•72% (5•52-8•01) for those aged 65-74 years and 19•1% (14•7-21•9) for those aged 75 years and older.Interpretation Our results are based on more complete ascertainment of COVID-19-related deaths in New York City than other places and thus probably reflect the true higher burden of death due to COVID-19 than that previously reported elsewhere. Given the high infection-fatality risk of SARS-CoV-2, governments must account for and closely monitor the infection rate and population health outcomes and enact prompt public health responses accordingly as the COVID-19 pandemic unfolds.

SARS-CoV-2 Infection Hospitalization Rate and Infection Fatality Rate Among the Non-Congregate Population in Connecticut

“… 4 , 5 , 6 , 7 , 8 However, most studies do not have a representative sample or separate out special populations, such as those in nursing homes. 5 , 9 Moreover, infection fatality rate is not an inherent characteristic of the disease, but rather a confluence of the pathogen virulence, sociodemographic and clinical characteristics of the population, health care availability and quality, therapeutic availability, and accurate counting and reporting of COVID-19-related deaths. As such, an overall infection fatality rate may not be very informative given the heterogeneity across regions.…”

The impact of immuno-aging on SARS-CoV-2 vaccine development

“…In March 2020, the World Health Organization (WHO) and Centers for Disease Control (CDC) declared a pandemic for the coronavirus, Severe acute respiratory syndrome (SARS-CoV-2) also known as coronavirus disease or COVID-19. Indeed, the case fatality ratio for those over 75 years old is 14.2%, while for those that are younger even by just 10 years, that number is significantly less at 4.87% [5]. The high fatality ratio of COVID-19 for those over 75 years old highlights the need for improved vaccine responses as part of a multifaceted approach to healthy aging.…”

On the Effectiveness of Digital Contact Tracing and Contact Prevention Under Varying COVID-19 Infection Detection Rates

“…IDR scenarios Although still debated, studies agree that IDR increases with age, and some studies estimate IDR can be as low as 10% for youngsters and 40% for the elderly even in wealthy cities, within wealthy countries as is the case of New York 12 . In this context, three IDR scenarios were considered, all with a symptomatic proportion of total infections corresponding to Poletti s results 16 .…”

“…However, this issue has been scarcely documented and noted by the community, even though infection detection rates are estimated to be below 12% for most countries, and 16% or less even for developed countries such as the United States of America, Canada, China, Sweden and The United Kingdom 11 . Accordingly, an analysis for the city of New York estimates an IDR of 15-20% 12 . Undetected infections are a key characteristic of the COVID-19 pandemic that severely impacts CT strategies, as no contact tracing is possible without diagnosis, which is most generally triggered by symptom onset.…”