Estimation of SARS-CoV-2 infection fatality rate by real-time antibody screening of blood donors

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  • Christian Erikstrup
  • Christoffer Egeberg Hother, 1] Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark. [2] Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark.
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  • Ole Birger Vestager Pedersen, Innovational Counsil, Zealand University Hospital, Region Zealand, Pediatric Department, Naestved Hospital, Naestved
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  • Kåre Mølbak, Hospital Lillebaelt, Middelfart, Denmark, University of Southern Denmark, Odense, Denmark, and Aarhus University Hospital, Aarhus, Denmark.
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  • Robert Leo Skov, Hospital Lillebaelt, Middelfart, Denmark, University of Southern Denmark, Odense, Denmark, and Aarhus University Hospital, Aarhus, Denmark.
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  • Dorte Kinggaard Holm, Department of Endocrinology, Odense University Hospital, Odense, Denmark ; Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark ; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
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  • Susanne Gjørup Sækmose, Innovational Counsil, Zealand University Hospital, Region Zealand
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  • Anna Christine Nilsson, Department of Endocrinology, Odense University Hospital, Odense, Denmark ; Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark ; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
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  • Patrick Terrence Brooks, 1] Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark. [2] Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark.
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  • Jens Kjærgaard Boldsen, l Department of Radiology, Aarhus University Hospital and Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark.
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  • Christina Mikkelsen, 1] Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark. [2] Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark., The Novo Nordisk Foundation Center for Basic Metabolic Research, Københavns Universitet - Graduate School of Health and Medical Sciences Faculty of Health and Medical Sciences, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark Danish Arrhythmia Research Centre, University of Copenhagen, Copenhagen, Denmark.
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  • Mikkel Gybel-Brask, 1] Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark. [2] Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark.
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  • Erik Sørensen, 1] Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark. [2] Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark.
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  • Khoa Manh Dinh
  • Susan Mikkelsen
  • Bjarne Kuno Møller
  • Thure Haunstrup, Aalborg Psychiatric University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
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  • Lene Harritshøj, 1] Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark. [2] Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark.
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  • Bitten Aagaard Jensen, Aalborg Psychiatric University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
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  • Henrik Hjalgrim, Hospital Lillebaelt, Middelfart, Denmark, University of Southern Denmark, Odense, Denmark, and Aarhus University Hospital, Aarhus, Denmark.
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  • Søren Thue Lillevang, Department of Endocrinology, Odense University Hospital, Odense, Denmark ; Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark ; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
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  • Henrik Ullum, 1] Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark. [2] Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark.

BACKGROUND: The pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has tremendous consequences for our societies. Knowledge of the seroprevalence of SARS-CoV-2 is needed to accurately monitor the spread of the epidemic and to calculate the infection fatality rate (IFR). These measures may help the authorities to make informed decisions and adjust the current societal interventions. The objective was to perform nationwide real-time seroprevalence surveying among blood donors as a tool to estimate previous SARS-CoV-2 infections and the population based IFR.

METHODS: Danish blood donors aged 17-69 years giving blood April 6 to May 3 were tested for SARS-CoV-2 immunoglobulin M and G antibodies using a commercial lateral flow test. Antibody status was compared between geographical areas and an estimate of the IFR was calculated. The seroprevalence was adjusted for assay sensitivity and specificity taking the uncertainties of the test validation into account when reporting the 95% confidence intervals (CI).

RESULTS: The first 20,640 blood donors were tested and a combined adjusted seroprevalence of 1.9% (CI: 0.8-2.3) was calculated. The seroprevalence differed across areas. Using available data on fatalities and population numbers a combined IFR in patients younger than 70 is estimated at 89 per 100,000 (CI: 72-211) infections.

CONCLUSIONS: The IFR was estimated to be slightly lower than previously reported from other countries not using seroprevalence data. The IFR is likely several fold lower than the current estimate. We have initiated real-time nationwide anti-SARS-CoV-2 seroprevalence surveying of blood donations as a tool in monitoring the epidemic.

Original languageEnglish
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN1058-4838
DOIs
Publication statusE-pub ahead of print - 25 Jun 2020

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