Reflections on designing population surveys for COVID-19 infection and prevalence
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EDITORIAL
Reflections on designing population surveys for COVID-19 infection and prevalence Akshay Swaminathan & S. V. Subramanian
Received: 10 August 2020 / Accepted: 12 August 2020 # American Aging Association 2020, corrected publication 2020
Introduction As COVID-19 continue to spread around the world, local and national leaders must closely track three metrics: the total number of active cases, the total number of recovered cases, and the total number of deaths due to COVID-19. These metrics can be used to understand the current risk of infection or mortality and the level of population immunity, and are critical to informing resource allocation and public policy. While many countries have infrastructure in place to record deaths, standard COVID-19 testing procedures that have been used since the beginning of the pandemic cannot reliably capture the total number of active or recovered cases. Since those who exhibit symptoms are more likely to get tested than asymptomatic individuals, confirmed cases are a skewed underestimate of the number of active cases. Furthermore, because standard polymerase chain reaction (PCR) tests for COVID-19 do not detect the presence of antibodies, they cannot detect prior A. Swaminathan Quantitative Sciences, Flatiron Health, New York, NY 10012, USA e-mail: [email protected]
infection. Changes in the availability of COVID-19 testing also affect the number of confirmed cases, which in turn affect the estimated case fatality ratio (CFR); the worldwide CFR of COVID-19 has varied from nearly 10% at the start of April to approximately 2.5% by August (Fig. 1). Without an accurate estimate of the total number of cases in the population, the mortality risk of COVID-19 cannot be accurately measured. Population-based surveys that test a representative sample of participants using both PCR and antibody tests can be used to estimate both the total number of active cases and recovered cases. The World Health Organization (WHO) recently released a protocol [1] for conducting large-scale serosurveys of COVID-19 for measuring cumulative population immunity and estimating the fraction of asymptomatic, pre-symptomatic or subclinical infections in the population. In this Editorial, we discuss the contribution of Merkely et al.’s survey of COVID-19 infection rate and prevalence in Hungary [2] in the context of other nationally representative studies of COVID-19, and the key elements of study design that could maximize the value of large-scale COVID-19 surveys for decisionmaking.
S. V. Subramanian (*) Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA 02138, USA e-mail: [email protected]
Leveraging institutional collaboration for COVID-19 surveys
S. V. Subramanian Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
Since the outbreak, several countries including the United States (US), Spain, Iceland, Germany, Norway, and India have started or completed national surveys that
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