Estimating unobserved SARS-CoV-2 infections in the United States
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Abstract
In early 2020, delays in availability of diagnostic testing for COVID-19 prompted questions about the extent of unobserved community transmission in the United States. We quantified unobserved infections in the United States during this time using a stochastic transmission model. Although precision of our estimates is limited, we conclude that many more thousands of people were infected than were reported as cases by the time a national emergency was declared and that fewer than 10% of locally acquired, symptomatic infections in the United States may have been detected over a period of a month. This gap in surveillance during a critical phase of the epidemic resulted in a large, unobserved reservoir of infection in the United States by early March.
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SciScore for 10.1101/2020.03.15.20036582: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Despite the advantages of our approach, there are limitations of it that should be acknowledged. First, our results were, in some cases, sensitive to deviations from baseline assumptions (Supplementary Information Text). Although most parameter scenarios we explored resulted in similar cumulative infections, higher values of R and earlier importation resulted in estimates in excess of 100,000 (Fig. S6). Second, our branching process …
SciScore for 10.1101/2020.03.15.20036582: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Despite the advantages of our approach, there are limitations of it that should be acknowledged. First, our results were, in some cases, sensitive to deviations from baseline assumptions (Supplementary Information Text). Although most parameter scenarios we explored resulted in similar cumulative infections, higher values of R and earlier importation resulted in estimates in excess of 100,000 (Fig. S6). Second, our branching process model assumes exponential growth, which could be affected by social distancing (24) or the buildup of immunity (25). Neither of those factors were likely to have had much influence on local transmission of SARS-CoV-2 in the US before March 13, however. Third, our parameter assumptions were based on analyses of data collected outside the US. Similar information has proven useful for other pathogens though, such as Zika and Ebola in past public health emergencies (26, 27). Fourth, we did not make use of airline data to model importation (28), but future applications of our method could incorporate that type of information. The limitations of our approach mean that results from our baseline scenario should be interpreted cautiously. Nonetheless, based on our sensitivity analysis, we conclude that unobserved SARS-CoV-2 infections in the US by March 12 likely numbered in the tens of thousands, and quite possibly in excess of 100,000. This result, considered together with extensive pre-symptomatic and asymptomatic transmission of SARS-CoV-2 (3, 4), sugg...
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.
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