Estimating the Percentage of a Population Infected with SARS-CoV-2 Using the Number of Reported Deaths: A Policy Planning Tool

Feikin, Daniel R.; Widdowson, Marc-Alain; Mulholland, Kim

The magnitude of future waves of Covid19 in a population will depend, in part, on the percentage of that population already infected, recovered, and presumably immune. Sero-epidemiological surveys can define the prevalence of SARS-CoV-2 antibodies in various populations. However, sero-surveys are resource-intensive and methodologically challenging, limiting widespread use. We propose a relatively simple method for calculating the percentage of a population infected, which depends on the number of reported Covid19 deaths, a figure usually more reliable and less dependent on variable testing practices than the total number of reported Covid19 cases, and the infection fatality rate, a figure that is relatively stable in similar populations. The method can be applied in different sized areas, such as states, districts, or cities. Such an approach can provide useful, real-time estimates of probable population immunity in settings unable to undertake multiple sero-surveys. This method is applicable to low- and lower-middle-income country (LMIC) settings where sero-survey data will likely be limited; however, better estimates of infection fatality rates and Covid19 death counts in LMICs are needed to improve the method’s accuracy. Information on the percentage of a population infected will help public health authorities in planning for future waves of Covid19, including where to most effectively deploy vaccines.