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. 2021 Jan 23;49(6):1963-1971.
doi: 10.1093/ije/dyaa198.

A demographic scaling model for estimating the total number of COVID-19 infections

Christina Bohk-Ewald  1   2 , Christian Dudel  1 , Mikko Myrskylä  1   2
Affiliations

A demographic scaling model for estimating the total number of COVID-19 infections

Christina Bohk-Ewald et al. Int J Epidemiol. .

Abstract

Background: Understanding how widely COVID-19 has spread is critical information for monitoring the pandemic. The actual number of infections potentially exceeds the number of confirmed cases.

Development: We develop a demographic scaling model to estimate COVID-19 infections, based on minimal data requirements: COVID-19-related deaths, infection fatality rates (IFRs), and life tables. As many countries lack IFR estimates, we scale them from a reference country based on remaining lifetime to better match the context in a target population with respect to age structure, health conditions and medical services. We introduce formulas to account for bias in input data and provide a heuristic to assess whether local seroprevalence estimates are representative for the total population.

Application: Across 10 countries with most reported COVID-19 deaths as of 23 July 2020, the number of infections is estimated to be three [95% prediction interval: 2-8] times the number of confirmed cases. Cross-country variation is high. The estimated number of infections is 5.3 million for the USA, 1.8 million for the UK, 1.4 million for France, and 0.4 million for Peru, or more than one, six, seven and more than one times the number of confirmed cases, respectively. Our central prevalence estimates for entire countries are markedly lower than most others based on local seroprevalence studies.

Conclusions: The national infection estimates indicate that the pandemic is far more widespread than the numbers of confirmed cases suggest. Some local seroprevalence estimates largely deviate from their corresponding national mean and are unlikely to be representative for the total population.

Keywords: COVID-19; bias assessment; indirect estimation; infection; local seroprevalence studies; prevalence.

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Figures

Figure 1
Figure 1
Confirmed cases versus estimated infections. Confirmed cases (non-floating, coloured bars) and estimated COVID-19 infections (quantiles 0.025, 0.5 and 0.975; floating, grey bars) for the 10 countries that have the largest numbers of reported deaths from COVID-19 as of 23 July 2020. Own calculations using data from Verity et al.,21 United Nations World Population Prospects23 and Johns Hopkins University Center for Systems Science and Engineering16
Figure 2
Figure 2
Estimated COVID-19 infection prevalence. Estimated population share of COVID-19 infections (quantiles 0.025, 0.5 and 0.975), from 22 January to 23 July 2020, for the 10 countries that have the largest numbers of reported deaths from COVID-19 as of 23 July 2020. Own calculations using estimates of Verity et al.,21 United Nations World Population Prospects23 and Johns Hopkins University Center for Systems Science and Engineering16
See this image and copyright information in PMC

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