What’s the best way to estimate and track COVID-19 mortality?

When used accurately, the symptomatic case fatality ratio (sCFR) and the infection fatality ratio (IFR) are better measures by which to observe COVID-19 epidemics than the commonly reported case fatality ratio (CFR), as stated by a new study published in PLOS Medicine by Anthony Hauser of the University of Bern, Switzerland, and colleagues.

Reliable estimate of the mortality from SARS-CoV-2 infection are necessary to understand the COVID-19 epidemic and develop public health interventions. Nevertheless, the frequently used CFR—the number of reported deaths divided by the number of reported cases—can be a deceptive measure of mortality linked with COVID-19. In the new study, researchers developed a computational model of the dynamics of transmission of SARS-CoV-2 along with COVID-19 associated mortality. The model took into account the delay between infection and death, the increased diagnosis of disease in people with severe symptoms, and stratified data by age.

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The researchers applied the model to Hubei province (China), Austria, Bavaria (Germany), Baden- Württemberg (Germany), Lombardy (Italy), Spain and Switzerland. In Hubei, the calculated IFR was 2.9% (95% credible interval [CrI] 2.4-3.5) while the CFR was 2.4%. In Europe, estimates of the IFR ranged from 0.5 (95% CrI 0.4-0.6) to 1.4% (95% CrI: 1.1-1.6) while the CFR ranged from 3.9% to 17.8%. Overall, estimates of sCFR and IFR were similar to each other and varied less geographically than the CFR.

“The CFR is not a good predictor of overall mortality from SARS-CoV-2 and should not be used for evaluation of policy or comparison across settings,” the authors say. “The sCFR and IFR, adjusted for [the right biases], are measures that can be used to improve and monitor clinical and public health strategies to reduce the deaths from SARS-CoV-2 infection.”

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