Importance of adequate COVID-19 case definitions in the SARS-CoV-2 pandemic
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Abstract
Background
Epidemiologic case definitions serve a myriad of purposes during a pandemic, including contact tracing and monitoring disease trends. It is unknown how any COVID-19 case definition fares against the current gold standard of molecular or antigen tests.
Methods
We calculated the diagnostic properties of five COVID-19 definitions (three of the Mexican government and two of the WHO) using open data of suspected COVID-19 cases in Mexico City from March 24th 2020 until January 31st 2021.
Results
All 1,632,420 people included in the analysis met the WHO suspected case definition (sensitivity 100%, specificity 0%). The WHO probable case definition was met by 1.4%, while the first and second Mexican suspected case had sensitivities of 61 and 62% and specificities of 58 and 62%, respectively. Confirmed case by epidemiological contact had a low sensitivity (33%) but slightly higher specificity (77%).
Conclusions
Case definitions should maximize sensitivity, especially in a high-transmission area such as Mexico City. The WHO suspected case definition has the potential for detecting most symptomatic cases. We underline the need for routine evaluation of case definitions as new evidence arises to maximize their usefulness.
Article activity feed
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SciScore for 10.1101/2021.06.13.21258845: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has several limitations. We used repurposed data that did not have information on several variables, such as anosmia, dysgeusia, and radiological imaging. The incidence of anosmia and/or dysgeusia in Mexican COVID-19 patients is unknown, but elsewhere it has been reported of 35% [10]. This could improve the sensitivity of the second MoH definition. Only …
SciScore for 10.1101/2021.06.13.21258845: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has several limitations. We used repurposed data that did not have information on several variables, such as anosmia, dysgeusia, and radiological imaging. The incidence of anosmia and/or dysgeusia in Mexican COVID-19 patients is unknown, but elsewhere it has been reported of 35% [10]. This could improve the sensitivity of the second MoH definition. Only one in ten ambulatory patients are tested, and these patients could differ in important ways that we are unable to account for, such as subjective disease severity. Furthermore, false negative tests are well known and limit our definition of gold standard [11-13]. This is especially important given the high post-test probability observed throughout the study period (>10%). Accounting for false negative tests would increase the post-test probability, and thus a negative test would not rule out the disease in high prevalence areas such as this. Our analysis supports the fact that case definitions should be formally evaluated as to ensure their usefulness.
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.
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