Does death from Covid-19 arise from a multi-step process?

European Journal of Epidemiology, vol. 36, pp. 1–9

Abstract

The Covid-19 death rate increases exponentially with age, and the main risk factors are having underlying conditions such as hypertension, diabetes, cardiovascular disease, severe chronic respiratory disease and cancer. These characteristics are consistent with the multi-step model of disease. We applied this model to Covid-19 case fatality rates (CFRs) from China, South Korea, Italy, Spain and Japan. In all countries we found that a plot of log(CFR) against log(age) was approximately linear with a slope of about 5. We also conducted similar analyses for selected other respiratory diseases. SARS showed a similar log-log age-pattern to that of Covid-19, albeit with a lower slope, whereas seasonal and pandemic influenza showed quite different age-patterns. Thus, death from Covid-19 and SARS appears to follow a distinct age-pattern, consistent with a multi-step model of disease that in the case of Covid-19 is probably defined by comorbidities and age producing immune-related susceptibility.

Authors 9

1. Neil Pearce corresponding

   London School of Hygiene & Tropical Medicine

   Affiliation as printed

   London School of Hygiene and Tropical Medicine, London, UK. Neil.Pearce@lshtm.ac.uk

   London School of Hygiene and Tropical Medicine, London, UK

2. Giovenale Moirano

   University of Turin

   Affiliation as printed

   Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy

3. Milena Maria Maule

   University of Turin

   Affiliation as printed

   Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy

4. Manolis Kogevinas

   Municipal Institute for Medical Research · Barcelona Institute for Global Health · Hospital del Mar Research Institute

   Affiliation as printed

   IMIM (Hospital del Mar Research Institute), Barcelona, Spain

   ISGlobal, Barcelona, Spain

5. Xavier Rodó

   Institució Catalana de Recerca i Estudis Avançats · Barcelona Institute for Global Health

   Affiliation as printed

   ICREA, Barcelona, Spain

   ISGlobal, Barcelona, Spain

6. Jan Paul Vandenbroucke Aachen

   Aarhus University · Leiden University Medical Center · London School of Hygiene & Tropical Medicine

   Affiliation as printed

   Aarhus University, Aarhus, Denmark

   Leiden University Medical Center, Leiden, The Netherlands

   London School of Hygiene and Tropical Medicine, London, UK

7. Christina M. J. E. Vandenbroucke‐Grauls

   Amsterdam University Medical Centers

   Affiliation as printed

   Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Amsterdam, The Netherlands

8. Fernando P. Polack

   Vanderbilt University · Infant Foundation

   Affiliation as printed

   Department of Pediatrics, Vanderbilt University, Nashville, TN, USA

   Fundacion INFANT, Buenos Aires, Argentina

9. Adnan Čustović

   Imperial College London

   Affiliation as printed

   National Heart and Lung Institute, Imperial College London, London, UK