Burden of disease methods: integrating COVID-19 to the cause list

Abstract

Until recently, most efforts to understand the comparative population health impact of COVID-19 have been made using mortality-based metrics. This has intensified discussion over methodological choices; in particular, how we value the life-years prematurely lost due to COVID-19. The direct impact of COVID-19 on population health has varied across countries, with wide variation in incidence and infection fatality rates. Understanding and quantifying the combined impact of morbidity and mortality is a key step to standardizing comparisons across countries, and to quantify the within-country impact of COVID-19 relative to other causes of disease and injury, sub-national areas or demographics. Burden of disease metrics, such as disability-adjusted life years (DALYs) offer a means of monitoring the direct population health impact of COVID-19 infection. They also offer opportunities to assess the indirect impact of the pandemic that has occurred due to national lockdowns and restrictions to vital services. We present recommendations on methodology for estimating DALYs for COVID-19 at national level. These include a protocol for calculations, the data requirements and approaches to overcome data gaps, a consensus health outcome, and the disability weights to describe the severity of each health outcome. These standardized approaches to estimating DALYs due to COVID-19 can allow for more accurate and comparable estimates of the burden of disease across populations.