Estimating the SARS-CoV-2 infected population fraction and the infection to-fatality ratio: A data-driven case study based on Swedish time series data

Wacker, A.; Jöud, A.; Bernhardsson, B.; Gerlee, P.; Gustafsson, F.; Soltesz, K.

Aim: To estimate the COVID-19 infection-to-fatality ratio (IFR), infection-to-case ratio (ICR), and infection-to-ICU admission ratio (IIAR) in Sweden; to suggest methods for time series reconstruction and prediction. Methods: We optimize a set of simple finite impulse response (FIR) models comprising of a scaling factor and time-delay between officially reported cases, ICU admissions and deaths time series using the least squares method. Combined with randomized PCR study results, we utilize this simple model to estimate the total number of infections in Sweden, and the corresponding IFR. Results: The model class provides a good fit between ICU admissions and deaths throughout 2020. Cases fit consistently from July 2020, by when PCR tests had become broadly available. We observe a diminished IFR in late summer as well as a strong decline during 2021, following the launch of a nation-wide vaccination program. The total number of infections during 2020 is estimated to $1.3$ million. Conclusions: A FIR model with a delta filter function describes the evolution of epidemiological data in Sweden well. The fact that we found IFR, ICR and IIAR constant over large parts of 2020 is in contrast with claims of healthcare adaptation or mutated virus variants importantly affecting these ratios. The model allows us to retrospectively estimate the COVID-19 epidemiological trajectory, and conclude that Sweden was far from herd immunity by the end of 2020.