Infection Fatality Rate (IFR)

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Infection fatality rate (IFR)

The most important metric in assessing death rate is the infection fatality rate (IFR),[80][c] which is
deaths attributed to disease divided by individuals infected (including all asymptomatic and
undiagnosed) to-date.[82] In March, a peer-reviewed analysis of pre-serology data from mainland
China yielded an overall IFR of 0.66% (with age-bracketed values ranging from 0.00161% for 0–
9 years to 0.595% for 50–59 years to 7.8% for > 80 years).[83]
In April, an IFR range of 0.12–1.08% was derived from non-peer-reviewed serology surveys, with
the upper bound characterized as much more credible and the range indicated as from 3 to 27
times deadlier than influenza (0.04%).[84]
In July, the CDC adopted the IFR as a "more directly measurable parameter for disease severity
for COVID-19" and computed an overall 'best estimate' for planning purposes for the U.S. of
0.65%.[85][86] In September, the CDC computed an age-bracketed ‘best estimate’ for the U.S. of
0.003% for 0–19 years; 0.02% for 20–49 years; 0.5% for 50–69 years; and 5.4% for 70+ years. [87]
[d]

In August, the WHO reported serology testing for three locations in Europe (with some data
through 2 June) that showed IFR overall estimates converging at approximately 0.5-1%. [81] A
systematic review article in The BMJ advised that "caution is warranted … using serological tests
for … epidemiological surveillance" and called for higher quality studies assessing accuracy with
reference to a standard of "RT-PCR performed on at least two consecutive specimens, and,
when feasible, includ[ing] viral cultures."[89][90] CEBM researchers have called for in-hospital 'case
definition' to record "CT lung findings and associated blood tests"[91] and for the WHO to produce
a "protocol to standardise the use and interpretation of PCR" with continuous re-calibration. [92]
In September, a Bulletin of the World Health Organization article by John Ioannides estimated
global IFR inferred from seroprevalence data at 0.23%[e] overall and 0.05% for people < 70 years,
much lower than estimates made earlier in the pandemic. Ioannides criticized prior "average IFR
… irresponsibly circulated widely in media and social media" as "probably extremely flawed as
they depended on erroneous modeling assumptions, and/or focused only on selecting mostly
studies from countries high death burden (that indeed have higher IFRs), and/or were done by
inexperienced authors who used overtly wrong meta-analysis methods in a situation where there
is extreme between-study heterogeneity.[93] As the data for his analysis was drawn
"predominantly from hard-hit epicenters", Ioannides indicates that even lower "average values of
0.15–0.25% … and 0.03–0.04% for <70 years) as of October 2020 are plausible." [93][94] He also
notes that in European countries with a large numbers of cases and deaths [95] and in the U.S.,
[96]
 "many, and in many cases most, deaths occurred in nursing homes”. [97]
On 6 October, Dr. Mike Ryan, director of the WHO's Health Emergencies Programme
announced "Our current best estimates tell us that about 10% of the global population may have
been infected by this virus."[98] Also in October, the Centre for Evidence-Based Medicine (CEBM)
reported a 'presumed estimate' of global IFR at between 0.10% to 0.35%, noting that this will
vary between populations due to differences in demographics.[99] These researchers noted a
decrease in IFR in England over time;[100][f] and, for the UK and Italy (the two Europeans nations
worst hit by COVID-19), attribute the rise in daily cases, stability in daily deaths, and shift of
cases to a younger population to waning viral circulation, misapplication of testing, and
misinterpretation of test results rather than to prevention, treatment, or virus mutation. [101]
Case fatality rate (CFR)

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