Mahan Ghafari: Department of Zoology, University of Oxford, Oxford, UK. mahan.ghafari@zoo.ox.ac.uk. ORCID
Oliver J Watson: Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
Ariel Karlinsky: Department of Economics, Hebrew University of Jerusalem, Jerusalem, Israel. ORCID
Luca Ferretti: Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Aris Katzourakis: Department of Zoology, University of Oxford, Oxford, UK. aris.katzourakis@zoo.ox.ac.uk.
The transmission dynamics and burden of SARS-CoV-2 in many regions of the world is still largely unknown due to the scarcity of epidemiological analyses and lack of testing to assess the prevalence of disease. In this work, we develop a quantitative framework based on excess mortality data to reconstruct SARS-CoV-2 transmission dynamics and assess the level of underreporting in infections and deaths. Using weekly all-cause mortality data from Iran, we are able to show a strong agreement between our attack rate estimates and seroprevalence measurements in each province and find significant heterogeneity in the level of exposure across the country with 11 provinces reaching near 100% attack rates. Despite having a young population, our analysis reveals that incorporating limited access to medical services in our model, coupled with undercounting of COVID-19-related deaths, leads to estimates of infection fatality rate in most provinces of Iran that are comparable to high-income countries.
References
JAMA. 2020 Jun 16;323(23):2425-2427
[PMID: 32421144]
