Substantial underestimation of SARS-CoV-2 infection in the United States due to incomplete testing and imperfect test accuracy
Substantial underestimation of SARS-CoV-2 infection in the United States due to incomplete testing and imperfect test accuracy
Abstract Accurate estimates of the burden of SARS-CoV-2 infection are critical to informing pandemic response. Current confirmed COVID-19 case counts in the U.S. do not capture the total burden of the pandemic because testing has been primarily restricted to individuals with moderate to severe symptoms due to limited test availability. We used a semi-Bayesian method to perform a probabilistic bias analysis on cumulative confirmed COVID-19 counts, incorporating relevant prior knowledge from existing studies about SARS-CoV-2 testing probabilities and diagnostic accuracy parameters while accounting for uncertainty. We estimate 6,275,072 cumulative infections compared to 721,245 confirmed cases (1.9% vs. 0.2% of the population) as of April 18, 2020. Accounting for uncertainty, the number of infections was 3 to 20 times higher than the number of confirmed cases. 86% (simulation interval: 64-99%) of this difference was due to incomplete testing, while 14% (0.3-36%) was due to imperfect test accuracy. Estimates of SARS-CoV-2 infections that transparently account for testing practices and diagnostic accuracy reveal that the pandemic is larger than confirmed case counts suggest.
Wu Sean L.、Pokpongkiat Nolan N.、Djajadi Stephanie、Benjamin-Chung Jade、Seth Anmol、Nguyen Anna、Hsiang Michelle S.、Crider Yoshika S.、Colford John M. Jr.、Mertens Andrew、Arnold Benjamin F.、Hubbard Alan、Reingold Art
Division of Epidemiology & Biostatistics, University of CaliforniaDivision of Epidemiology & Biostatistics, University of CaliforniaDivision of Epidemiology & Biostatistics, University of CaliforniaDivision of Epidemiology & Biostatistics, University of CaliforniaDivision of Epidemiology & Biostatistics, University of CaliforniaDivision of Epidemiology & Biostatistics, University of CaliforniaDepartment of Pediatrics, University of Texas Southwestern Medical Center||Malaria Elimination Initiative, Global Health Group, University of California||Department of Pediatrics, University of CaliforniaDivision of Epidemiology & Biostatistics, University of California||Energy & Resources Group, University of CaliforniaDivision of Epidemiology & Biostatistics, University of CaliforniaDivision of Epidemiology & Biostatistics, University of CaliforniaFrancis I. Proctor Foundation, University of California||Department of Ophthalmology, University of CaliforniaDivision of Epidemiology & Biostatistics, University of CaliforniaDivision of Epidemiology & Biostatistics, University of California
医学研究方法医药卫生理论
Wu Sean L.,Pokpongkiat Nolan N.,Djajadi Stephanie,Benjamin-Chung Jade,Seth Anmol,Nguyen Anna,Hsiang Michelle S.,Crider Yoshika S.,Colford John M. Jr.,Mertens Andrew,Arnold Benjamin F.,Hubbard Alan,Reingold Art.Substantial underestimation of SARS-CoV-2 infection in the United States due to incomplete testing and imperfect test accuracy[EB/OL].(2025-03-28)[2025-04-28].https://www.medrxiv.org/content/10.1101/2020.05.12.20091744.点此复制
评论