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Serosurveillance and the COVID-19 Epidemic in the USUndetected, Uncertain, and Out of Control

Educational Objective
To understand how Serosurveillance can help us understand the true effect of COVID-19 on the US population
1 Credit CME

The true extent of the coronavirus disease 2019 (COVID-19) epidemic in the US is unknown. The 3.4 million confirmed cases reported (as of July 15, 2020) likely represent only a fraction of all the infections that have occurred in the US thus far. Limited laboratory capacity and restrictive testing guidelines early in the epidemic resulted in large numbers of undetected incident infections. Approximately 40% of all SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infections are thought to be asymptomatic,1 and active surveillance for infections without symptoms is limited even now, nearly 5 months after the first COVID-19 cases were reported in Seattle2 and Chicago.3 The true cumulative incidence of infection—a basic but critically important measurement—remains uncertain at a time when communities nationwide are struggling to navigate an ongoing, unprecedented public health emergency, and while apprehensions about the near-term and long-term trajectories of the epidemic loom large.

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Article Information

Published Online: July 21, 2020. doi:10.1001/jama.2020.14017

Correction: This article was corrected on July 24, 2020, to fix the doi and link in reference 4.

Corresponding Author: Tyler S. Brown, MD, Massachusetts General Hospital, 55 Fruit St, GJ504, Boston, MA 02114 (tsbrown@mgh.harvard.edu).

Conflict of Interest Disclosures: None reported.

References
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2.
Holshue  ML , DeBolt  C , Lindquist  S ,  et al; Washington State 2019-nCoV Case Investigation Team.  First case of 2019 novel coronavirus in the United States.   N Engl J Med. 2020;382(10):929-936. doi:10.1056/NEJMoa2001191 PubMedGoogle ScholarCrossref
3.
Ghinai  I , McPherson  TD , Hunter  JC ,  et al; Illinois COVID-19 Investigation Team.  First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA.   Lancet. 2020;395(10230):1137-1144. doi:10.1016/S0140-6736(20)30607-3 PubMedGoogle ScholarCrossref
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Havers  FP , Reed  C , Lim  T ,  et al.  Seroprevalence of antibodies to SARS-CoV-2 in 10 sites in the United States, March 23-May 12, 2020.   JAMA Intern Med. Published online July 21, 2020. doi:10.1001/jamainternmed.2020.4130 PubMedGoogle Scholar
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Vehovar  V , Toepoel  V , Steinmetz  S.  Non-probability sampling. In: Wolf  C , Joye  D , Smith  TW , Fu  Y , eds.  The SAGE Handbook of Survey Methodology. Sage; 2016. doi:10.4135/9781473957893.n22
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Rosenberg  ES , Tesoriero  JM , Rosenthal  EM ,  et al.  Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York.   Ann Epidemiol. 2020;S1047-2797(20)30201-5. doi:10.1016/j.annepidem.2020.06.004PubMedGoogle Scholar
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Harvard Global Health Institute. Daily COVID-19 tests vs tracing targets. Published 2020. Accessed July 15, 2020. https://globalepidemics.org/july-6-2020-state-testing-targets/
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US Centers for Disease Control and Prevention. COVIDView: Key updates for week 27, ending July 4, 2020. Updated July 10, 2020. Accessed July 15, 2020. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
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