Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Mar 23, 2022
Date Accepted: Oct 13, 2022
Date Submitted to PubMed: Oct 14, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The Importance of Incorporating At-Home Testing into SARS-CoV-2 Point Prevalence Estimates: Findings from a U.S. National Cohort, February 2022
ABSTRACT
Background:
Given the availability of rapid at-home tests for SARS-CoV-2, and the lack of mechanism in the United States for reporting rapid at-home results, standard surveillance underestimates the true extent of active infections in the population.
Objective:
The objective of this analysis was to identify the extent to which cases of SARS-CoV-2 may be underreported in standard surveillance during the recent surge of the Omicron variant.
Methods:
A survey on COVID-19 exposure, infection, and testing was administered to calculate point prevalence of SARS-CoV-2 among a diverse sample of cohort adults between 8-22 February 2022. Three-point prevalence estimates were calculated among the cohort 1) proportion positives based on PCR and/or rapid antigen tests, 2) proportion positive based on probable untested cases and positive cases reported from testing exclusively via rapid at-home tests, 3) a complete point prevalence estimate based on all definitions of a case. Percent positivity and prevalence differences across booster status were also examined.
Results:
Among a cohort of 4328, there were a total of 644 cases. The standard surveillance point prevalence estimate was 5.5% (95% CI: 4.8% - 6.2%). The point prevalence of probable cases and those testing positive exclusively via rapid at-home tests was 9.4% (95% CI: 8.5% - 10.3%). The complete point prevalence was 14.9% (95% CI: 13.8% - 16.0%). The percent positivity among PCR and/or rapid antigen tests was 28.1%. No statistically significant differences were observed in prevalence between participants with a COVID-19 booster compared to fully vaccinated and non-boosted participants.
Conclusions:
Our study suggests a substantial proportion of cases were missed by standard surveillance systems during the Omicron wave, when at-home testing was common. Point prevalence surveys may be a rapid tool to be used to understand SARS-CoV-2 prevalence and would be especially important during case surges to measure the scope and spread of active infections in the population.
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