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How deadly is COVID-19?

A Stanford professor has produced perhaps the most comprehensive attempt to estimate the infection fatality rate

October 16, 2020

11:24 AM

16 October 2020

11:24 AM

What percentage of people who are infected with COVID-19 will go on to die of the disease? The dramatic response to the pandemic on the part of almost all governments around the world has been based on the idea that COVID-19 is a far more lethal disease than seasonal flu, which is often quoted as having an infection fatality rate (IFR) of 0.1 percent. The World Health Organization (WHO) is often quoted as claiming that COVID-19 has an IFR of 3.2 percent — a claim that goes back to a press conference in early March when it, in fact, said that the case fatality rate (CFR) at that stage was 3.2 percent.

The CFR is the division of known deaths by known cases — the denominator omitting the many cases that have not been confirmed by diagnosis. In a disease where large numbers of people are asymptomatic, the case fatality rate is bound to differ widely from the infection fatality rate.

Estimates of the IFR for COVID-19 have tended to settle in the range of 0.5 percent to 1 percent. The Imperial College paper of March 16, which did so much to inform UK policy on COVID by predicting that 250,000 people could die unless the government introduced stricter social distancing measures, assumed an IFR of 0.9 percent. A subsequent Imperial College study put it at 0.66 percent.

Now, John Ioannidis of Stanford University has produced perhaps the most comprehensive attempt to estimate the IFR for COVID-19 to date. In a peer-reviewed study published in the Bulletin of the World Health Organization he looked at 61 studies from around the world that have tried to measure the true prevalence of COVID-19 through serological studies. He then looked at the number of recorded COVID-19 deaths in the area to which they referred and used it to compute the local IFR.


It produced estimates for IFR which ranged between 0 and 1.63 percent, with a median figure of 0.27 percent.

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That is quite a range, which could be due to a number of factors including the quality of medical treatments; local demography, in particular the age profile of the local population; the number of hospital-acquired infections; different ways of recording deaths; and possibly some level of pre-existing defense from serious symptoms gained from previous exposure to other coronaviruses. Most of the serological studies, noted Ioannidis, came from places with relatively high numbers of deaths. The study also calculated IFRs for the under 70s, which came out between 0 and 0.31 percent, with a median of 0.05 percent.

But if we take the median IFR for all age groups of 0.29 percent, how does this compare with seasonal flu? Data does not exist for flu in the way it does for COVID-19, but one of the most comprehensive sources of data is the Centers for Disease Control (CDC) in the US. In the season 2016/17 (the last for which full figures are available, more recent figures being provisional) the CDC estimated 29 million cases of flu across the US, resulting in between 29,000 and 61,000 deaths. That gives an IFR of between 0.1 and 0.2 percent. Meanwhile, the WHO estimates that seasonal influenza has an infection fatality rate that is ‘usually well below 0.1 percent’.

From the research thus far, it still seems fair to say that COVID-19 is quite a bit deadlier than seasonal flu.

This article was originally published on The Spectator’s UK website.


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