Variability in Coronavirus Disease-2019 Case, Death, and Testing Rates in the United States and Worldwide
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Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has been associated with a worldwide pandemic. We assessed data as of November 25, 2020 from our combined laboratories and as reported for states in the United States (US) and countries for case, death, and testing rates per million to determine causes of rate differences. SARS-CoV-2 naso-pharyngeal (NP) RNA testing in 1,179,912 subjects in 47 states (39 of which with >100 cases) are reported, with a mean 9.3% positive rate, comparable to the 7.0% rate reported nationwide. In 91 previously positive (2-4 weeks) subjects, NP swab testing was twice as likely to be positive (58.6%) as saliva samples (21.5%). We also documented that NP swabs could remain positive for 6 weeks or longer. Our positive rates per state agreed reasonably well with reported national data (r=0.609, P <0.0001). The highest US case rates per million were in the mid-west; the highest death and testing rates were in the northeast. Of 47 countries, the highest case, death, and testing rates per million were mainly in Europe and the Americas, with the lowest rates in Asia. Correlations between case and death rates and case and testing rates were very different between states (0.076 and -0.093, respectively) and countries (0.763 and 0.600, respectively). In conclusion, outpatient saliva testing was not as sensitive as NP testing for detection, and the marked variability in case and death rates was most likely due to differences in public health measures, viral and human genetic differences and age of cases, rather than due to differences in testing rates.
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SciScore for 10.1101/2020.10.13.20172957: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: For this research, patient data were extracted from medical records without name or identification number and were analyzed as anonymized data, determined exempt from institutional review board approval by Advarra Institutional Review Board (Columbia, MD).
Consent: We also carried out a paired NP swab and saliva sample study, where we collected samples from previously positive subjects (n=91, mean age 53 years, 53% female) using an approved human institutional review board protocol (Trinity Health of New England, Hartford, CT); informed written consent was obtained from each subject.Randomization not detected. Blinding not detected. Power Analysis not detected. S… SciScore for 10.1101/2020.10.13.20172957: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: For this research, patient data were extracted from medical records without name or identification number and were analyzed as anonymized data, determined exempt from institutional review board approval by Advarra Institutional Review Board (Columbia, MD).
Consent: We also carried out a paired NP swab and saliva sample study, where we collected samples from previously positive subjects (n=91, mean age 53 years, 53% female) using an approved human institutional review board protocol (Trinity Health of New England, Hartford, CT); informed written consent was obtained from each subject.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable We also carried out a paired NP swab and saliva sample study, where we collected samples from previously positive subjects (n=91, mean age 53 years, 53% female) using an approved human institutional review board protocol (Trinity Health of New England, Hartford, CT); informed written consent was obtained from each subject. 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: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.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.
- No funding statement was detected.
- No protocol registration statement was detected.
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