Inadequate knowledge about the extent of the coronavirus disease 2019 (COVID-19) epidemic challenges public health response and planning. Most reports of confirmed cases rely on polymerase chain reaction–based testing of symptomatic patients.1 These estimates of confirmed cases miss individuals who have recovered from infection, with mild or no symptoms, and individuals with symptoms who have not been tested due to limited availability of tests.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Neeraj Sood, PhD, University of Southern California, University Park Campus, Verna & Peter Dauterive Hall, 635 Downey Way, Los Angeles, CA 90089 (firstname.lastname@example.org).
Accepted for Publication: May 1, 2020.
Published Online: May 18, 2020. doi:10.1001/jama.2020.8279
Author Contributions: Dr Sood had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: Sood, Simon, Ebner, Reynolds, Bendavid, Bhattacharya.
Drafting of the manuscript: Sood, Bendavid, Bhattacharya.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Sood, Simon, Reynolds, Bendavid, Bhattacharya.
Obtained funding: Sood, Eichner, Reynolds, Bendavid.
Administrative, technical, or material support: Sood, Simon, Ebner, Eichner, Reynolds, Bhattacharya.
Supervision: Sood, Simon, Ebner, Reynolds, Bhattacharya.
Conflict of Interest Disclosures: Dr Sood reported receiving funding from Jedel Foundation, USC Schwarzenegger Institute, USC Lusk Center, USC President's Office, Catherine Ahmed, Brent Bayless, Carole King, Daniel Eichner, Regina Nordhal, Tore Nordhal, and Gauri Jauhar during the conduct of the study; and reported serving as a scientific advisor to Payssurance and Virta Health; serving as an expert witness for the American Medical Association and Goldman, Ismail, Tomaselli, Brennan, and Baum; serving as an international expert for the China Development Research Foundation and the Pharmaceutical Research and Manufacturers of America; and receiving grants from the Agency for Healthcare Research and Quality, the National Institutes of Health, the National Institute for Health Care Management Foundation, Health Care Services Corporation, and the Patient-Centered Outcomes Research Institute outside the submitted work. Drs Bhattacharya and Bendavid reported receiving support from Jedel Foundation and the Stanford COVID-19 Seroprevalence Studies Fund during the conduct of the study. No other disclosures were reported.
Funding/Support: We received partial financial support for this project through the Stanford COVID-19 Seroprevalence Studies fund. We acknowledge funding from USC Schwarzenegger Institute, USC Lusk Center, USC President’s Office, Jedel Foundation, LRW Group, Soap Box Sample, Foundation for Clean Competition, Partnership for Clean Competition, and several individual donors.
Role of the Funder/Sponsor: Funding organizations and donors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank Jim Tedrow, BS, MT, The Compliance Resource Group; Thomas Kupiec, PhD, ARL Bio Pharma Inc; Manish J. Butte, MD, PhD, University of California, Los Angeles; Jason Brooks, LRW Group; and Thomas MaCurdy, Frank Wolak, and John P. A. Ioannidis, MD, DSc, Stanford University, for contributing to study design. We thank Ricardo Basurto-Davila, PhD, and Irene Vidyanti, PhD, Los Angeles County Chief Information Office, for contributing to study design and data collection. We thank Kevin de Leon, BA, and Conyers Davis, MA, Schwarzenegger Institute for State and Global Policy at the University of Southern California; and Carole King, MEd, Sol Price School of Public Policy, University of Southern California, Los Angeles, for logistical support during data collection and securing funding. We thank John Walton Senterfitt and Alysia Kwon, ScM, Los Angeles County Department of Public Health, for IRB support. We thank Elinor Gaida, MBA, MPH, and Jacqueline Rosales, BS, LRW Group, for contributing to recruiting and data collection. We thank Janelle Cyprich, BS, Acacia Hori, BA, Alexandra Obremskey, BS, Katharine B. Stiers, BA, Silena Te, BA, Omar Toubat, BA, and other medical student volunteers from USC Keck School of Medicine for contributions to data collection. None of the individuals acknowledged received compensation from the study team.
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