Nowcasting fatal COVID-19 infections on a regional level in Germany.

We analyse the temporal and regional structure in mortality rates related to COVID-19 infections, making use of the openly available data on registered cases in Germany published by the Robert Koch Institute on a daily basis. Estimates for the number of present-day infections that will, at a later date, prove to be fatal are derived through a nowcasting model, which relates the day of death of each deceased patient to the corresponding day of registration of the infection. Our district-level modelling approach for fatal infections disentangles spatial variation into a global pattern for Germany, district-specific long-term effects and short-term dynamics, while also taking the age and gender structure of the regional population into account. This enables to highlight areas with unexpectedly high disease activity. The analysis of death counts contributes to a better understanding of the spread of the disease while being, to some extent, less dependent on testing strategy and capacity in comparison to infection counts. The proposed approach and the presented results thus provide reliable insight into the state and the dynamics of the pandemic during the early phases of the infection wave in spring 2020 in Germany, when little was known about the disease and limited data were available.