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.
Keywords: SARS-CoV-2; incidence; probability survey; serology; viral detection.
【저자키워드】 SARS-CoV-2, serology, Viral detection, incidence, probability survey, 【초록키워드】 COVID-19, coronavirus disease, public health, IgG, IgM, Coronavirus disease 2019, coronavirus, serology, antibody, COVID-19 pandemic, Infection, coronavirus 2, Antigen, Probability, Severe acute respiratory syndrome, Adults, infections, Viral, Random sample, Immunoglobulin, nucleocapsid, Seropositivity, Reporting, Viral detection, nasal swab, respiratory, differential diagnosis, seropositive, cumulative incidence, Blood, antibody waning, Emergency use, fatality, disparity, IFR, can not, credible interval, subgroup, black, acute respiratory syndrome, antigen capture assay, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, subgroups, specimen, white, fraction, National, cumulative, random, nasal swabs, responses, difference, reported, conducted, provided, accounted, calculated, adjusted, CrI, infected with SARS-CoV-2, 【제목키워드】 United States,