Severe Acute Respiratory Syndrome Coronavirus 2 Cumulative Incidence, United States, August 2020–December 2020. (10th July 2021)

• Record Type: Journal Article
• Authors: Sullivan, Patrick Sean; Siegler, Aaron J; Shioda, Kayoko; Hall, Eric W; Bradley, Heather; Sanchez, Travis; Luisi, Nicole; Valentine-Graves, Mariah; Nelson, Kristin N; Fahimi, Mansour; Kamali, Amanda; Sailey, Charles; Lopman, Benjamin A
• Is Part Of: Clinical infectious diseases. Volume 74:Number 7(2022)
• Page Start: 1141
• Page End: 1150
• Publication Date: 2021-07-10
• Subjects: SARS-CoV-2 -- serology -- probability survey -- incidence -- viral detection; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab626
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Reported coronavirus disease 2019 (COVID-19) cases underestimate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. We conducted a national probability survey of US households to estimate cumulative incidence adjusted for antibody waning. Methods: From August–December 2020 a random sample of US addresses were mailed a survey and self-collected nasal swabs and dried blood spot cards. One adult household member completed the survey and mail specimens for viral detection and total (immunoglobulin [Ig] A, IgM, IgG) nucleocapsid antibody by a commercial, emergency use authorization–approved antigen capture assay. We estimated cumulative incidence of SARS-CoV-2 adjusted for waning antibodies and calculated reported fraction (RF) and infection fatality ratio (IFR). Differences in seropositivity among demographic, geographic, and clinical subgroups were explored. Results: Among 39 500 sampled households, 4654 respondents provided responses. Cumulative incidence adjusted for waning was 11.9% (95% credible interval [CrI], 10.5%–13.5%) as of 30 October 2020. We estimated 30 332 842 (CrI, 26 703 753–34 335 338) total infections in the US adult population by 30 October 2020. RF was 22.3% and IFR was 0.85% among adults. Black non-Hispanics (Prevalence ratio (PR) 2.2) and Hispanics (PR, 3.1) were more likely than White non-Hispanics to be seropositive. Conclusions: One in 8 US adults had been infected with SARS-CoV-2 by October 2020; however, few had been accounted for in public health reporting. The COVID-19 pandemic is likely substantially underestimated by reported cases. Disparities in COVID-19 by race observed among reported cases cannot be attributed to differential diagnosis or reporting of infections in population subgroups. Abstract : One in 8 US adults had been infected with severe acute respiratory syndrome coronavirus 2 by late October 2020; however, few had been accounted for in public health reporting. The scope of the coronavirus disease 2019 pandemic is likely substantially underestimated by reported cases. We conducted a national probability survey of US households to estimate the cumulative incidence adjusted for antibody waning.