A scaling approach to estimate the age-dependent COVID-19 infection fatality ratio from incomplete data

SARS-CoV-2 has disrupted the life of billions of people around the world since the first outbreak was officially declared in China at the beginning of 2020. Yet, important questions such as how deadly it is or its degree of spread within different countries remain unanswered. In this work, we exploit the 'universal' increase of the mortality rate with age observed in different countries since the beginning of their respective outbreaks, combined with the results of the antibody prevalence tests in the population of Spain, to unveil both unknowns. We test these results with an analogous antibody rate survey in the canton of Geneva, Switzerland, showing a good agreement. We also argue that the official number of deaths over 70 years old might be importantly underestimated in most of the countries, and we use the comparison between the official records with the number of deaths mentioning COVID-19 in the death certificates to quantify by how much. Using this information, we estimate the infection fatality ratio (IFR) for the different age segments and the fraction of the population infected in different countries assuming a uniform exposure to the virus in all age segments. We also give estimations for the non-uniform IFR using the sero-epidemiological results of Spain, showing a very similar increase of the fatality ratio with age. Only for Spain, we estimate the probability (if infected) of being identified as a case, being hospitalized or admitted in the intensive care units as function of age. In general, we observe a nearly exponential increase of the fatality ratio with age, which anticipates large differences in total IFR in countries with different demographic distributions, with numbers that range from 1.82% in Italy, to 0.62% in China or even 0.14% in middle Africa.

Automated summary

This study reveals the infection fatality rate and population infection ratio of SARS-CoV-2 in different age segments and countries by exploiting the observed increase in mortality rate with age and antibody prevalence tests. The research shows significant variations in total IFR among different countries.