Statistical models for COVID-19 infection fatality rates and diagnostic test data
Date
2023
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Abstract
The COVID-19 pandemic has had devastating impacts worldwide. Early in the pandemic, little was known about the emerging disease. To inform policy, it was essential to develop data science tools to inform public health policy and interventions. We developed methods to fill three gaps in the literature. A first key task for scientists at the start of the pandemic was to develop diagnostic tests to classify an individual's disease status as positive or negative and to estimate community prevalence. Researchers rapidly developed diagnostic tests, yet there was a lack of guidance on how to select a cutoff to classify positive and negative test results for COVID-19 antibody tests developed with limited numbers of controls with known disease status. We propose selecting a cutoff using extreme value theory and compared this method to existing methods through a data analysis and simulation study. Second, there lacked a cohesive method for estimating the infection fatality rate (IFR) of COVID-19 that fully accounted for uncertainty in the fatality data, seroprevalence study data, and antibody test characteristics. We developed a Bayesian model to jointly model these data to fully account for the many sources of uncertainty. A third challenge is providing information that can be used to compare seroprevalence and IFR across locations to best allocate resources and target public health interventions. It is particularly important to account for differences in age-distributions when comparing across locations as age is a well-established risk factor for COVID-19 mortality. There is a lack of methods for estimating the seroprevalence and IFR as continuous functions of age, while adequately accounting for uncertainty. We present a Bayesian hierarchical model that jointly estimates seroprevalence and IFR as continuous functions of age, sharing information across locations to improve identifiability. We use this model to estimate seroprevalence and IFR in 26 developing country locations.