The prevalence of SARS-CoV-2 infection and other public health outcomes during the BA.2/BA.2.12.1 surge, New York City, April–May 2022

This article has been Reviewed by the following groups

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Background

Routine case surveillance data for SARS-CoV-2 are incomplete, unrepresentative, missing key variables of interest, and may be increasingly unreliable for timely surge detection and understanding the true burden of infection.

Methods

We conducted a cross-sectional survey of a representative sample of 1030 New York City (NYC) adult residents ≥18 years on May 7-8, 2022. We estimated the prevalence of SARS-CoV-2 infection during the preceding 14-day period. Respondents were asked about SARS-CoV-2 testing, testing outcomes, COVID-like symptoms, and contact with SARS-CoV-2 cases. SARS-CoV-2 prevalence estimates were age- and sex-adjusted to the 2020 U.S. population. We triangulated survey-based prevalence estimates with contemporaneous official SARS-CoV-2 counts of cases, hospitalizations, and deaths, as well as SARS-CoV-2 wastewater concentrations.

Results

We show that 22.1% (95% CI 17.9–26.2%) of respondents had SARS-CoV-2 infection during the two-week study period, corresponding to ~1.5 million adults (95% CI 1.3-1.8 million). The official SARS-CoV-2 case count during the study period is 51,218. Prevalence is estimated at 36.6% (95% CI 28.3–45.8%) among individuals with co-morbidities, 13.7% (95% CI 10.4–17.9%) among those 65+ years, and 15.3% (95% CI 9.6–23.5%) among unvaccinated persons. Among individuals with a SARS-CoV-2 infection, hybrid immunity (history of both vaccination and infection) is 66.2% (95% CI 55.7–76.7%), 44.1% (95% CI 33.0–55.1%) were aware of the antiviral nirmatrelvir/ritonavir, and 15.1% (95% CI 7.1–23.1%) reported receiving it. Hospitalizations, deaths and SARS-CoV-2 virus concentrations in wastewater remained well below that during the BA.1 surge.

Conclusions

Our findings suggest that the true magnitude of NYC’s BA.2/BA.2.12.1 surge may have been vastly underestimated by routine case counts and wastewater surveillance. Hybrid immunity, bolstered by the recent BA.1 surge, likely limited the severity of the BA.2/BA.2.12.1 surge.

Article activity feed

  1. Melissa Briggs-Hagen

    Review 2: "The Prevalence of SARS-CoV-2 Infection and Uptake of COVID-19 Antiviral Treatments During the BA.2/BA.2.12.1 Surge, New York City, April-May 2022"

    Overall, reviewers note that the manuscript doesn't report details such as response rates or seem to control for potential confounders, which limits the manuscript's believability.

  2. Travis Lim

    Review 1: "The Prevalence of SARS-CoV-2 Infection and Uptake of COVID-19 Antiviral Treatments During the BA.2/BA.2.12.1 Surge, New York City, April-May 2022"

    Overall, reviewers note that the manuscript doesn't report details such as response rates or seem to control for potential confounders, which limits the manuscript's believability.

  3. SciScore for 10.1101/2022.05.25.22275603: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: 17 The study protocol was approved by the Institutional Review Board at the City University of New York (CUNY).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.


    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).


    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our cross-sectional study has limitations, including self-report of testing outcomes over a 14-day recall period (subject to recall bias) and limited sample size especially in subgroups of those with evidence of COVID-19. For those with prior COVID, we did not capture information on timing of prior infections, which underestimates the degree of hybrid protection, though a substantial proportion of NYC adults were infected during the recent BA.1 surge.9,16 Our case definition would likely capture some, but not all, of the estimated 20-30% of individuals whose SARS-CoV-2 infection may remain asymptomatic throughout their infection,30,31 as well as those who were symptomatic but were not aware of a close contact. Finally, our survey could not include those whose primary language was not English or Spanish. Strengths include the representative nature of the study, the study’s timing at the start of the BA.2 /BA.2.12.1 surge, and measurement of several important factors that are not currently available through routine surveillance, including outcomes among those who do not test positive with a provider, prevalence among individuals vulnerable to COVID-19, hybrid protection, and awareness/uptake of nirmatrelvir/ritonavir.

    Results from TrialIdentifier: No clinical trial numbers were referenced.


    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.


    Results from JetFighter: We did not find any issues relating to colormaps.


    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.


    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.