Estimates of global SARS-CoV-2 infection exposure, infection morbidity, and infection mortality rates in 2020

Abstract

We aimed to estimate, albeit crudely and provisionally, national, regional, and global proportions of respective populations that have been infected with SARS-CoV-2 in the first year after the introduction of this virus into human circulation, and to assess infection morbidity and mortality rates, factoring both documented and undocumented infections. The estimates were generated by applying mathematical models to 159 countries and territories. The percentage of the world's population that has been infected as of 31 December 2020 was estimated at 12.56% (95% CI: 11.17–14.05%). It was lowest in the Western Pacific Region at 0.66% (95% CI: 0.59–0.75%) and highest in the Americas at 41.92% (95% CI: 37.95–46.09%). The global infection fatality rate was 10.73 (95% CI: 10.21–11.29) per 10,000 infections. Globally per 1000 infections, the infection acute-care bed hospitalization rate was 19.22 (95% CI: 18.73–19.51), the infection ICU bed hospitalization rate was 4.14 (95% CI: 4.10–4.18). If left unchecked with no vaccination and no other public health interventions, and assuming circulation of only wild-type variants and no variants of concern, the pandemic would eventually cause 8.18 million deaths (95% CI: 7.30–9.18), 163.67 million acute-care hospitalizations (95% CI: 148.12–179.51), and 33.01 million ICU hospitalizations (95% CI: 30.52–35.70), by the time the herd immunity threshold is reached at 60–70% infection exposure. The global population remained far below the herd immunity threshold by end of 2020. Global epidemiology reveals immense regional variation in infection exposure and morbidity and mortality rates.