Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 27:371:m4509.
doi: 10.1136/bmj.m4509.

Infection fatality risk for SARS-CoV-2 in community dwelling population of Spain: nationwide seroepidemiological study

Roberto Pastor-Barriuso  1   2   3 , Beatriz Pérez-Gómez  1   2   3 , Miguel A Hernán  4 , Mayte Pérez-Olmeda  5 , Raquel Yotti  6 , Jesús Oteo-Iglesias  5   7 , Jose L Sanmartín  8 , Inmaculada León-Gómez  1   2 , Aurora Fernández-García  2   5 , Pablo Fernández-Navarro  1   2 , Israel Cruz  9 , Mariano Martín  8 , Concepción Delgado-Sanz  1   2 , Nerea Fernández de Larrea  1   2 , Jose León Paniagua  6 , Juan F Muñoz-Montalvo  8 , Faustino Blanco  8 , Amparo Larrauri  1   2   10 , Marina Pollán  11   2   10 ; ENE-COVID Study Group
Collaborators, Affiliations

Infection fatality risk for SARS-CoV-2 in community dwelling population of Spain: nationwide seroepidemiological study

Roberto Pastor-Barriuso et al. BMJ. .

Abstract

Objective: To estimate the infection fatality risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), based on deaths with confirmed coronavirus disease 2019 (covid-19) and excess deaths from all causes.

Design: Nationwide seroepidemiological study.

Setting: First wave of covid-19 pandemic in Spain.

Participants: Community dwelling individuals of all ages.

Main outcome measures: The main outcome measure was overall, and age and sex specific, infection fatality risk for SARS-CoV-2 (the number of covid-19 deaths and excess deaths divided by the estimated number of SARS-CoV-2 infections) in the community dwelling Spanish population. Deaths with laboratory confirmed covid-19 were obtained from the National Epidemiological Surveillance Network (RENAVE) and excess all cause deaths from the Monitoring Mortality System (MoMo), up to 15 July 2020. SARS-CoV-2 infections in Spain were derived from the estimated seroprevalence by a chemiluminescent microparticle immunoassay for IgG antibodies in 61 098 participants in the ENE-COVID nationwide seroepidemiological survey between 27 April and 22 June 2020.

Results: The overall infection fatality risk was 0.8% (19 228 of 2.3 million infected individuals, 95% confidence interval 0.8% to 0.9%) for confirmed covid-19 deaths and 1.1% (24 778 of 2.3 million infected individuals, 1.0% to 1.2%) for excess deaths. The infection fatality risk was 1.1% (95% confidence interval 1.0% to 1.2%) to 1.4% (1.3% to 1.5%) in men and 0.6% (0.5% to 0.6%) to 0.8% (0.7% to 0.8%) in women. The infection fatality risk increased sharply after age 50, ranging from 11.6% (8.1% to 16.5%) to 16.4% (11.4% to 23.2%) in men aged 80 or more and from 4.6% (3.4% to 6.3%) to 6.5% (4.7% to 8.8%) in women aged 80 or more.

Conclusion: The increase in SARS-CoV-2 infection fatality risk after age 50 appeared to be more noticeable in men than in women. Based on the results of this study, fatality from covid-19 was greater than that reported for other common respiratory diseases, such as seasonal influenza.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the Spanish Ministry of Health, Institute of Health Carlos III, and Spanish National Health System for the submitted work; no relationships with any organisations that might have a financial interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Flowchart of participants in the seroepidemiological survey of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infection in the community dwelling Spanish population (ENE-COVID), 27 April-22 June 2020. CMIA=chemiluminescent microparticle immunoassay
Fig 2
Fig 2
Infection fatality risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by sex and age, based on deaths with confirmed covid-19 (top) and excess deaths from all causes (bottom), for the community dwelling population during the first wave of the covid-19 pandemic in Spain 2020. Shaded regions represent 95% confidence intervals for infection fatality risk
See this image and copyright information in PMC

References

    1. Faust JS, Del Rio C. Assessment of deaths from COVID-19 and from seasonal influenza. JAMA Intern Med 2020;180:1045-6. 10.1001/jamainternmed.2020.2306. - DOI - PubMed
    1. Ioannidis J. The infection fatality rate of COVID-19 inferred from seroprevalence data. medRxiv 2020;2020.05.13.20101253 10.1101/2020.05.13.20101253. - DOI - PMC - PubMed
    1. Metcalf CJE, Farrar J, Cutts FT, et al. Use of serological surveys to generate key insights into the changing global landscape of infectious disease. Lancet 2016;388:728-30. 10.1016/S0140-6736(16)30164-7. - DOI - PMC - PubMed
    1. Meyerowitz-Katz G, Merone L. A systematic review and meta-analysis of published research data on COVID-19 infection fatality rates. Int J Infect Dis 2020;101:138-48. 10.1016/j.ijid.2020.09.1464. - DOI - PMC - PubMed
    1. Perez-Saez J, Lauer SA, Kaiser L, et al. Serocov-POP Study Group Serology-informed estimates of SARS-CoV-2 infection fatality risk in Geneva, Switzerland. Lancet Infect Dis 2020;S1473-3099(20)30584-3. 10.1016/S1473-3099(20)30584-3. - DOI - PMC - PubMed