Cumulative Incidence of SARS-CoV-2 Infections Among Adults in Georgia, United States, August to December 2020

Abstract Background Reported coronavirus disease 2019 (COVID-19) cases underestimate true severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Data on all infections, including asymptomatic infections, are needed. To minimize biases in estimates from reported cases and seropreval...

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Published in:	The Journal of infectious diseases 2022-02, Vol.225 (3), p.396-403
Main Authors:	Chamberlain, Allison T, Toomey, Kathleen E, Bradley, Heather, Hall, Eric W, Fahimi, Mansour, Lopman, Benjamin A, Luisi, Nicole, Sanchez, Travis, Drenzek, Cherie, Shioda, Kayoko, Siegler, Aaron J, Sullivan, Patrick Sean
Format:	Article
Language:	eng
Subjects:	Adult Antibodies, Viral - blood Coronaviruses COVID-19 COVID-19 - epidemiology Georgia - epidemiology Hispanic people Humans Incidence Infections Major and Brief Reports Seroepidemiologic Studies Serology Severe acute respiratory syndrome coronavirus 2
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Summary:	Abstract Background Reported coronavirus disease 2019 (COVID-19) cases underestimate true severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Data on all infections, including asymptomatic infections, are needed. To minimize biases in estimates from reported cases and seroprevalence surveys, we conducted a household-based probability survey and estimated cumulative incidence of SARS-CoV-2 infections adjusted for antibody waning. Methods From August to December 2020, we mailed specimen collection kits (nasal swabs and blood spots) to a random sample of Georgia addresses. One household adult completed a survey and returned specimens for virus and antibody testing. We estimated cumulative incidence of SARS-CoV-2 infections adjusted for waning antibodies, reported fraction, and infection fatality ratio (IFR). Differences in seropositivity among demographic, geographic, and clinical subgroups were explored with weighted prevalence ratios (PR). Results Among 1370 participants, adjusted cumulative incidence of SARS-CoV-2 was 16.1% (95% credible interval [CrI], 13.5%–19.2%) as of 16 November 2020. The reported fraction was 26.6% and IFR was 0.78%. Non-Hispanic black (PR, 2.03; 95% confidence interval [CI], 1.0–4.1) and Hispanic adults (PR, 1.98; 95% CI, .74–5.31) were more likely than non-Hispanic white adults to be seropositive. Conclusions As of mid-November 2020, 1 in 6 adults in Georgia had been infected with SARS-CoV-2. The COVID-19 epidemic in Georgia is likely substantially underestimated by reported cases. Using data from a probability survey of households in Georgia, United States we estimated that 1.3 million adults aged ≥18 years experienced SARS-CoV-2 infections by 16 November 2020, of whom 1 in 4 were reported and of whom 0.78% died.
ISSN:	0022-1899 1537-6613