Estimating the infection-fatality risk of SARS-CoV-2 in New York City during the spring 2020 pandemic wave: a model-based analysis

Background As the COVID-19 pandemic continues to unfold, the infection-fatality risk (ie, risk of death among all infected individuals including those with asymptomatic and mild infections) is crucial for gauging the burden of death due to COVID-19 in the coming months or years. Here, we estimate the infection-fatality risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in New York City, NY, USA, the first epidemic centre in the USA, where the infection-fatality risk remains unclear. Methods In this model-based analysis, we developed a meta-population network model-inference system to estimate the underlying SARS-CoV-2 infection rate in New York City during the 2020 spring pandemic wave using available case, mortality, and mobility data. Based on these estimates, we further estimated the infection-fatality risk for all ages overall and for five age groups (<25, 25-44, 45-64, 65-74, and >= 75 years) separately, during the period March 1 to June 6, 2020 (ie, before the city began a phased reopening). Findings During the period March 1 to June 6, 2020, 205 639 people had a laboratory-confirmed infection with SARS-CoV-2 and 21 447 confirmed and probable COVID-19-related deaths occurred among residents of New York City. We estimated an overall infection-fatality risk of 1.39% (95% credible interval 1.04-1.77) in New York City. Our estimated infection-fatality risk for the two oldest age groups (65-74 and >= 75 years) was much higher than the younger age groups, with a cumulative estimated infection-fatality risk of 0.116% (0.0729-0.148) for those aged 25-44 years and 0.939% (0.729-1.19) for those aged 45-64 years versus 4.87% (3.37-6.89) for those aged 65-74 years and 14.2% (10.2-18.1) for those aged 75 years and older. In particular, weekly infection-fatality risk was estimated to be as high as 6.72% (5.52-8.01) for those aged 65-74 years and 19.1% (14.7-21.9) for those aged 75 years and older. Interpretation Our results are based on more complete ascertainment of COVID-19-related deaths in New York City than other places and thus probably reflect the true higher burden of death due to COVID-19 than that previously reported elsewhere. Given the high infection-fatality risk of SARS-CoV-2, governments must account for and closely monitor the infection rate and population health outcomes and enact prompt public health responses accordingly as the COVID-19 pandemic unfolds. Copyright (C) 2020 Elsevier Ltd. All rights reserved.