Recording the numbers of those who die with Coronavirus will inflate the CFR as opposed to those that died from Coronavirus, which will deflate the CFR.
Report from the Italian National Institute of Health: analysed 355 fatalities and found only three patients (0.8%) had no prior medical conditions. See Table 1 in the paper; (99% who died had one pre-existing health condition): 49% had three or more health conditions; 26% had two other ‘pathologies’, and 25% had one.
The most common problems in the 355 who died were: 76% high blood pressure; 36% diabetes, and 33% ischemic heart disease.
The average age of deceased and COVID-19 positive patients was 79.5 years (median 80.5, range 31-103). The median age of those that died was >15 years higher than patients who contracted the infection (median age: died 81 years – infected 63 years).
Data comes from cases diagnosed by regional reference laboratories (N = 73,780). Source
Produced by the Istituto Superiore di Sanità (ISS) the data is collected through a dedicated web platform and includes all the cases of COVID-19 diagnosed by the regional reference laboratories. The data are updated daily by Region although some information may take a few days to come through.
Age effects by age band:*
*The Statistical model used is a grouped-binomial logistic regression with log-link function with main effects for age-band and sex (no two-way interaction terms). Deviance statistic is 30.9 on 6 degrees of freedom.)
| Females | Males | |||
| Age band | CFR (%) | 95% CI | CFR (%) | 95% CI |
| 30-39 | 0.26 | 0.16 to 0.42 | 0.43 | 0.27 to 0.69 |
| 40-49 | 0.55 | 0.43 to 0.70 | 0.91 | 0.72 to 1.16 |
| 50-59 | 1.23 | 1.08 to 1.40 | 2.05 | 1.81 to 2.33 |
| 60-69 | 4.02 | 3.71 to 4.34 | 6.67 | 6.22 to 7.15 |
| 70-79 | 11.86 | 11.26 to 12.50 | 19.71 | 18.98 to 20.47 |
| 80-89 | 17.94 | 17.11 to 18.80 | 29.81 | 28.78 to 30.87 |
| >=90 | 19.41 | 18.05 to 20.88 | 32.26 | 30.01 to 34.68 |
| Marginal estimates of the case-fatality rate by age. | ||||
The risk ratios give the ratio of case-fatality rate in one age-band with the case-fatality rate in the reference age-band (here set to age 60-69).
| Category | Risk ratio | 95% CI |
| Age 30-39 | 0.06 | 0.038 to 0.10 |
| Age 40-49 | 0.14 | 0.11 to 0.17 |
| Age 50-59 | 0.31 | 0.27 to 0.35 |
| Age 60-69 (Reference) | 1.00 | – |
| Age 70-79 | 2.95 | 2.7 to 3.2 |
| Age 80-89 | 4.47 | 4.1 to 4.8 |
| Age 90+ | 4.83 | 4.4 to 5.3 |
| Female | 1.00 | – |
| Male | 1.66 | 1.58 to 1.74 |
| Rate ratio estimates (95% CI) for CFR under independence model | ||
For example, a ratio of 4.47 (aged 80 to 89) means that the case fatality rate is 4.47 times higher than those aged 60 to 69. For people aged 40 to 49 the case fatality rate is (1 – 0.14)*100 = 86% lower than in people aged 60 – 69. Similarly, the case-fatality rate for men was 66% higher than the case-fatality rate in women.
| Age band | Cases (n) | Deaths | CFR (%) |
| 18-29 | 474 | 0 | 0.00 |
| 30-39 | 1068 | 0 | 0.00 |
| 40-49 | 1819 | 0 | 0.00 |
| 50-59 | 2193 | 5 | 0.23 |
| 60-70 | 780 | 6 | 0.77 |
| Total | 6334 | 11 | 0.17 |
| Distribution of cases, deaths and case-fatality in health professionals – data is in the consolidation phase and does not include cases with unknown age | |||
Iceland has tested a higher proportion of people than any other country (9,768 individuals), equivalent to 26,762 per million inhabitants the highest in the world (as a comparison, South Korea has tested 6,343 individuals).
Screening suggests 0.5% are infected; the correct figure is likely higher due to asymptomatics and many not seeking testing: estimates suggest the real number infected is 1%.
Iceland, currently reports two deaths in 963 patients, CFR. 0.21%. If 1% of the population (364,000) is infected, then the corresponding IFR would be 0.05%. However, they have limited infections in the elderly as their test and quarantine measures have seemingly shielded this group, and the deaths will lag by about two weeks after the infection.
Iceland’s higher rates of testing, the smaller population, and their ability to ascertain all those with Sars-CoV-2 means they can obtain. an accurate estimate of the CFR and the IFR during the pandemic (most countries will only be able to do this after the pandemic). Current data from Iceland suggests their IFR is somewhere between 0.01% and 0.19%.
Imperial College, London, modelled the impact of COVID-19, interventions to reduce the spread and case fatality.
Summary of their assumptions: Impact assessment of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand pdf.
Infection Fatality Rate (IFR) estimates were based on Verity et al. and adjusted for a non-uniform attack rate to give an IFR of 0.9% (95% credible interval 0.4%-1.4%).
Published in MedRxiv (preprint and not been peer-reviewed) Verity obtained age-stratified CFR estimates from China and individual data on 1,334 cases identified outside of mainland China. Verity et al. estimated an overall IFR for China of 0.66% (0.39%,1.33%) that increased with age.