Article Data

  • Views 2368
  • Dowloads 201

Original Research

Open Access

Estimating SARS-CoV-2 infection fatality rate using data from one of the most affected areas worldwide

  • Giovanni Landoni1,2
  • Carolina Faustini1
  • Marilena Marmiere1
  • Carolina Soledad Romero Garcìa3,4
  • Annalisa Ruggeri5
  • Alberto Zangrillo1,2

1Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy

2Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy

3Hospital General Universitario de Valencia, 46014 Valencia, Spain

4Division of Research Methodology, European University, Valencia, Spain

5Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy

DOI: 10.22514/sv.2021.149 Vol.17,Issue 5,September 2021 pp.30-33

Submitted: 19 July 2021 Accepted: 10 August 2021

Published: 08 September 2021

*Corresponding Author(s): Giovanni Landoni E-mail:


The real estimate of the infection fatality rate of SARS-CoV-2 is a pivotal aspect of the COVID-19 pandemic. However, this number is still debated, since both the numerator and the denominator are uncertain. Data analysis from the most affected areas in the world minimizes computational errors and represents a unique approach for estimating infection fatality rate. We first extracted data from PubMed/Medline, Google, traditional media and social media to obtain the rate of SARS-CoV-2 antibodies seroprevalence in the most affected and best-studied areas in the world: Val Seriana (Italy), Ischgl (Austria) and Manaus (Brasil). We then searched mortality data from national institutes of statistics and calculated excess mortality. We estimated the infection fatality rate considering several scenarios according to the mortality attributable to COVID-19 and the proportion of the population infected with the virus. We found that the seropositivity was surprisingly close to 40% in all the considered areas. We calculated the SARS-CoV-2 infection fatality rate for Val Seriana, using from half to the entire excess mortality (1208 deaths) and considering from 40% to 80% of the population as being infected with SARS-CoV-2. In the most conservative scenario, infection fatality rate was as low as 0.55%, while in the worst-case one it was 2.2%. We found that the seroconversion rate in the most affected areas worldwide is about 40%. We consequently estimated the infection fatality rate to be between 0.55% and 2.2% in an area with a relatively elderly population.


SARS-CoV-2; Infection fatality rate; Antibodies; COVID-19; Mortality; Lethality

Cite and Share

Giovanni Landoni,Carolina Faustini,Marilena Marmiere,Carolina Soledad Romero Garcìa,Annalisa Ruggeri,Alberto Zangrillo. Estimating SARS-CoV-2 infection fatality rate using data from one of the most affected areas worldwide. Signa Vitae. 2021. 17(5);30-33.


[1] Johns Hopkins University Medicine. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University of medicine. Available at: https://coronavirus.jhu. edu/map.html (Accessed: 5 September 2021).

[2] World Health Organization. Estimating mortality from COVID-19 –Scientific Brief. 2020. Available at: (Accessed: 5 September 2021).

[3] BergamoNews. Bassa Val Seriana, sierologici a tappeto: su 22mila abitanti positivo il 42.3%. 2020. Available at: https: // (Accessed: 1 August 2021).

[4] Coronavirus: ‘Momentous’ errors worsened Austria ski resort outbreak. 2020. Available at: (Accessed: 5 September 2021).

[5] Buss LF, Prete CA, Abrahim CMM, Mendrone A, Salomon T, de Almeida-Neto C, et al. Three-quarters attack rate of SARS-CoV-2 in the Brazilian Amazon during a largely unmitigated epidemic. Science. 2020; 371: 288–292.

[6] Our World in Data. Excess mortality during the Coronavirus pandemic (COVID-19). 2021. Available at: (Accessed: 5 September 2021).

[7] Channappanavar R, Fett C, Zhao J, Meyerholz DK, Perlman S. Virus-specific memory CD8 T cells provide substantial protection from lethal severe acute respiratory syndrome coronavirus infection. Journal of Virology. 2014; 88: 11034–11044.

[8] Sekine T, Perez-Potti A, Rivera-Ballesteros O, Strålin K, Gorin JB, Olsson A, et al. Robust T Cell Immunity in Convalescent Individuals with Asymptomatic or Mild COVID-19. Cell. 2020; 183: 158–168.e14.

[9] Knabl L, Mitra T, Kimpel J, Rössler A, Volland A, Walser A, et al. High SARS-CoV-2 seroprevalence in children and adults in the Austrian ski resort of Ischgl. Communications Medicine. 2021; 1: 4.

[10] Perico L, Tomasoni S, Peracchi T, Perna A, Pezzotta A, Remuzzi G, et al. COVID-19 and lombardy: TESTing the impact of the first wave of the pandemic. EBioMedicine. 2020; 61: 103069.

[11] L’ECO DI BERGAMO. Val Seriana, il 42.3% a contatto col virus – Più colpiti dai 45 anni in su e le donne. 2020. Available at: (Accessed: 1 August 2021).

[12] ISTAT - Istituto Nazionale di Statistica. L’andamento dei decessi nel periodo 1 gennaio - 31 dicembre per gli anni 2015-2020. Dati anticipatori per l’anno 2020 sulla Base dati integrata della mortalità giornaliera comunale. Available at: publish=yes&:origin=viz_share_link&:showVizHome=no#3 (Accessed: 1 August 2021).

[13] Popolazione per età, sesso e stato civile 2019. 2019. Available at: (Accessed: 1 August 2021).

[14] Ministero della Salute. Covid-19, studio ISS: ecco quando un malato contagiava tre persone. 2020. Available at: http: // (Accessed: 5 September 2021).

[15] Sabino EC, Buss LF, Carvalho MPS, Prete CA, Crispim MAE, Fraiji NA, et al. Resurgence of COVID-19 in Manaus, Brazil, despite high seroprevalence. The Lancet. 2021; 397: 452–455.

[16] Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. Journal of the American Medical Association. 2020; 323: 1775–1776.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time