Population-level COVID-19 mortality risk for non-elderly individuals overall and for non-elderly individuals without underlying diseases in pandemic epicenters

John P. A. Ioannidis; Cathrine Axfors; Despina G. Contopoulos-Ioannidis

As the coronavirus disease 2019 (COVID-19) pandemic has spread widely around the globe, 1, 2 estimates about its eventual impact in terms of total number of deaths have varied widely, as they are mostly based on mathematical models with various speculative assumptions. Regardless, it is very crucial to estimate how much smaller the risk of death is among non-elderly people (<65 years old) as opposed to older individuals and how frequent deaths are in people who are <65 years old and have no underlying predisposing diseases. Media have capitalized on stories of young healthy individuals with severe, fatal outcomes. However, the majority of patients dying with SARS-CoV-2 are elderly and the large majority of the deceased may have severe underlying diseases. Exaggeration should be avoided in responding to the pandemic. 3 Accurate estimates of death risk have important implications for the projecting eventual total loss of quality-adjusted life-years, since deaths of young, healthy people contribute far more qualityadjusted life-years lost than deaths in elderly individuals with pre-existing morbidity. Knowledge of COVID-19 death risks for people <65 years old at the population level may affect the viability of different management strategies for the pandemic. People <65 years old represents the lion's share of the workforce.