# Case Fatality Rate (CFR) and Infection Fatality Rate (IFR)

by Raywat Deonandan, PhD

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00:00 Hello.

00:01 In this video we'll look at some of the indicators for understanding the propagation of infectious disease epidemics.

00:08 In particular, the CFR - the case fatality rate.

00:11 That's the proportion of people who get the disease who die.

00:15 The infection fatality rate, the IFR, that's the proportion of all the people who get the disease who die, not just the ones we know about.

00:22 See the difference there? And lastly we'll look at the attack rate which is one of the most important ways we have of measuring the impact, the progression and the intensity of an infectious disease outbreak.

00:35 Thank you.

00:37 The first one is the case fatality rate or CFR and it's one of the most important indicators that we use.

00:46 We're measuring a lethality especially as lethality changes over time.

00:53 Now it's important to note that the CFR, the case fatality rate isn't actually a true rate, or even a ratio.

01:02 It's actually a proportion of incidents, so proportion of the incidence rate that results in people dying, and we usually give it as a percentage so we compute the proportion and multiply it by 100.

01:18 It's very simple.

01:19 It's just the number of deaths divided by the number of cases.

01:24 So the fraction of known confirmed cases of the disease that results in death.

01:31 And it's important to note that the deaths are assumed to have been caused by the disease.

01:37 And that's a bit of a controversy of course, because medically it's sometimes difficult to determine whether the deaths were indeed caused by this particular infection.

01:49 Now, while the CFR the case fatality rate is what we compute on a day to day basis, based upon the information in front of us, it's really an estimate of a more important indicator, which is the IFR or the infection fatality rate.

02:07 The infection fatality rate is the proportion of all infections caused by the disease who end up dying.

02:15 Let's go over that again.

02:16 The CFR is the fraction of known cases that die and the IFR is the fraction of all cases that die.

02:27 Of course, the IFR is never really truly known because it's impossible to know all of the cases.

02:35 You only end up knowing the cases that present themselves for testing, the cases who are symptomatic and who have access to the health care system to be tested.

02:45 And you never really know of all the deaths because some people die at home never having encountered the health care system.

02:52 So the IFR is a theoretical construct really, and we never really get a good sense of it until the epidemic is actually over, when it's run its course and pretty much most of the cases have been investigated For COVID-19, we use the antibody tests at the population level to get a true sense of the denominator i.e. the number of actual cases of infection to get us a better sense of the IFR.

03:23 IFR just like the CFR is expressed as a percentage.

03:27 So for some historical context, let's look at the IFR as for the 1957 USA flu, and the IFR for the 1918 Spanish Flu.

03:40 We think in 1957, that strain of influenza had an infection fatality rate of about 0.27%.

03:48 Again, these are estimates based on models.

03:51 And the Spanish flu, we think was over 2%, which is a very high number.

03:56 Right now, as of this date, for COVID-19, we think the IFR is probably between 0.5 and 1% but that's subject to change depending upon new modeling, new information, new data.

04:10 The IFR comparisons give us a good sense of again, how deadly a disease is but also how to quantify it and compare it to other epidemics.

The lecture Case Fatality Rate (CFR) and Infection Fatality Rate (IFR) by Raywat Deonandan, PhD is from the course Pandemics.

### Included Quiz Questions

1. Case fatality rate (CFR)
2. Infection fatality rate
3. Odds ratio
5. Risk ratio
1. The CFR is an actual percentage while the IFR is a theoretical construct.
2. CFR = IFR
3. The CFR is always less than the IFR.
4. The IFR is used to approximate the CFR.
5. Mathematical models are needed to calculate the CFR, post-pandemic.

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