Dynamics of SARS-CoV-2 infection hospitalisation and infection fatality ratios over 23 months in England
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Published:2023-05-25
Issue:5
Volume:21
Page:e3002118
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ISSN:1545-7885
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Container-title:PLOS Biology
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language:en
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Short-container-title:PLoS Biol
Author:
Eales OliverORCID,
Haw David,
Wang Haowei,
Atchison Christina,
Ashby Deborah,
Cooke Graham S.,
Barclay Wendy,
Ward Helen,
Darzi Ara,
Donnelly Christl A.,
Chadeau-Hyam Marc,
Elliott Paul,
Riley Steven
Abstract
The relationship between prevalence of infection and severe outcomes such as hospitalisation and death changed over the course of the COVID-19 pandemic. Reliable estimates of the infection fatality ratio (IFR) and infection hospitalisation ratio (IHR) along with the time-delay between infection and hospitalisation/death can inform forecasts of the numbers/timing of severe outcomes and allow healthcare services to better prepare for periods of increased demand. The REal-time Assessment of Community Transmission-1 (REACT-1) study estimated swab positivity for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in England approximately monthly from May 2020 to March 2022. Here, we analyse the changing relationship between prevalence of swab positivity and the IFR and IHR over this period in England, using publicly available data for the daily number of deaths and hospitalisations, REACT-1 swab positivity data, time-delay models, and Bayesian P-spline models. We analyse data for all age groups together, as well as in 2 subgroups: those aged 65 and over and those aged 64 and under. Additionally, we analysed the relationship between swab positivity and daily case numbers to estimate the case ascertainment rate of England’s mass testing programme. During 2020, we estimated the IFR to be 0.67% and the IHR to be 2.6%. By late 2021/early 2022, the IFR and IHR had both decreased to 0.097% and 0.76%, respectively. The average case ascertainment rate over the entire duration of the study was estimated to be 36.1%, but there was some significant variation in continuous estimates of the case ascertainment rate. Continuous estimates of the IFR and IHR of the virus were observed to increase during the periods of Alpha and Delta’s emergence. During periods of vaccination rollout, and the emergence of the Omicron variant, the IFR and IHR decreased. During 2020, we estimated a time-lag of 19 days between hospitalisation and swab positivity, and 26 days between deaths and swab positivity. By late 2021/early 2022, these time-lags had decreased to 7 days for hospitalisations and 18 days for deaths. Even though many populations have high levels of immunity to SARS-CoV-2 from vaccination and natural infection, waning of immunity and variant emergence will continue to be an upwards pressure on the IHR and IFR. As investments in community surveillance of SARS-CoV-2 infection are scaled back, alternative methods are required to accurately track the ever-changing relationship between infection, hospitalisation, and death and hence provide vital information for healthcare provision and utilisation.
Funder
Department of Health and Social Care
Medical Research Council
National Institute for Health Research
Wellcome Trust
Centres for Disease Control and Prevention
MRC Centre for Environment and Health
Health Data Research UK
NIHR Imperial Biomedical Research Centre
NIHR HPRU in Chemical and Radiation Threats and Hazards, and Environmental Exposures and Health
British Heart Foundation Centre for Research Excellence
UK Dementia Research Institute
The Huo Family Foundation
Cancer Research UK
H2020-EXPANSE
H2020-LongITools
Publisher
Public Library of Science (PLoS)
Subject
General Agricultural and Biological Sciences,General Immunology and Microbiology,General Biochemistry, Genetics and Molecular Biology,General Neuroscience
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