Evaluating the massive underreporting and undertesting of COVID-19 cases in multiple global epicenters

Lau, Hien; Khosrawipour, Tanja; Kocbach, Piotr; Ichii, Hirohito; Bania, Jacek; Khosrawipour, Veria

doi:10.1016/j.pulmoe.2020.05.015

Cited by 270 publications

(242 citation statements)

References 11 publications

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“…Second, Singapore may have a higher proportion of people with COVID-19 who were successfully traced and diagnosed as confirmed cases. Because of ascertainment bias, estimations of confirmed CFR for COVID-19 can be sensitive to the epidemiological surveillance capacity [ 3 ]. In Singapore, where contact tracing has been practiced very extensively, the implemented public health measures may have had an impact on the COVID-19 CFR estimate.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Case Fatality Risk of COVID-19 between Singapore and Japan

Kayano

Nishiura

2020

JCM

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The crude case fatality risk (CFR) for coronavirus disease (COVID-19) in Singapore is remarkably small. We aimed to estimate the unbiased CFR by age for Singapore and Japan and compare these estimates by calculating the standardized mortality ratio (SMR). Age-specific CFRs for COVID-19 were estimated in real time, adjusting for the delay from illness onset to death. The SMR in Japan was estimated by using the age distribution of the Singapore population. Among cases aged 60–69 years and 70–79 years, the age-specific CFRs in Singapore were estimated as 1.84% (95% confidence interval: 0.46–4.72%) and 5.57% (1.41–13.97%), respectively, and those in Japan as 5.52% (4.55–6.62%) and 15.49% (13.81–17.27%), respectively. The SMR of COVID-19 in Japan, when compared with Singapore as the baseline, was estimated to be 1.46 (1.09–2.96). The overall CFR for Singapore is lower than that for Japan. It is possible that the circulating variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Singapore causes a milder clinical course of COVID-19 infection compared with other strains. If infection with a low-virulence SARS-CoV-2 variant provides protection against infection by high-virulence strains, the existence of such a strain is encouraging news for the many countries struggling to suppress this virus.

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Section: Introductionmentioning

confidence: 99%

A Comparison of Case Fatality Risk of COVID-19 between Singapore and Japan

Kayano

Nishiura

2020

JCM

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“…However, these numbers and the current mapping of disease spread present an incomplete picture of the outbreak largely due to the lack of adequate testing, particularly as undetected infected cases are the main source of disease spread (2)(3)(4)(5)(6)(7). It is estimated that the reported detection rate of actual COVID-19 cases is only 1-2% (5). As of September 2020, the United States and Brazil remain the top two countries with the highest number of COVID-19 cases and deaths worldwide.…”

Section: Introductionmentioning

confidence: 99%

Validating and modeling the impact of high-frequency rapid antigen screening on COVID-19 spread and outcomes

Nash

Badea

Reddy

et al. 2020

Preprint

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High frequency screening of populations has been proposed as a strategy in facilitating control of the COVID-19 pandemic. Here we use computational modeling, coupled with clinical data from a rapid antigen test, to predict the impact of frequent rapid testing on COVID-19 spread and outcomes. Using patient nasopharyngeal swab specimens, we demonstrate that the sensitivity and specificity of the rapid antigen test compared to quantitative real-time polymerase chain reaction (qRT-PCR) are 84.7% and 85.7%, respectively; moreover, sensitivity correlates directly with viral load. Based on COVID-19 data from three regions in the United States and Sao Jose do Rio Preto, Brazil, we show that high frequency, strategic population-wide rapid testing, even at varied accuracy levels, diminishes COVID-19 infections, hospitalizations, and deaths at a fraction of the cost of nucleic acid detection via qRT-PCR. We propose large-scale antigen-based surveillance as a viable strategy to control SARS-CoV-2 spread and to enable societal re-opening.

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“…However, these numbers and the current mapping of disease spread present an incomplete picture of the outbreak largely due to the lack of adequate testing, particularly as undetected infected cases are the main source of disease spread [2][3][4][5][6][7] . It is estimated that the reported detection rate of actual COVID-19 cases is only 1-2% 5 . As of November 2020, the United States, Brazil, and India remain the top three countries with the highest number of COVID-19 cases and deaths worldwide.…”

Section: Introductionmentioning

confidence: 99%

Validating and modeling the impact of high-frequency rapid antigen screening on COVID-19 spread and outcomes

Nash¹,

Badea²,

Reddy³

et al. 2020

Preprint

View full text Add to dashboard Cite

High frequency screening of populations has been proposed as a strategy in facilitating control of the COVID-19 pandemic. We use computational modeling, coupled with clinical data from rapid antigen tests, to predict the impact of frequent viral antigen rapid testing on COVID-19 spread and outcomes. Using patient nasal or nasopharyngeal swab specimens, we demonstrate that the sensitivity/specificity of two rapid antigen tests compared to quantitative real-time polymerase chain reaction (qRT-PCR) are 80.0%/91.1% and 84.7%/85.7%, respectively; moreover, sensitivity correlates directly with viral load. Based on COVID-19 data from three regions in the United States and São José do Rio Preto, Brazil, we show that high frequency, strategic population-wide rapid testing, even at varied accuracy levels, diminishes COVID-19 infections, hospitalizations, and deaths at a fraction of the cost of nucleic acid detection via qRT-PCR. We propose large-scale antigen-based surveillance as a viable strategy to control SARS-CoV-2 spread and to enable societal re-opening.

show abstract

Evaluating the massive underreporting and undertesting of COVID-19 cases in multiple global epicenters

Cited by 270 publications

References 11 publications

A Comparison of Case Fatality Risk of COVID-19 between Singapore and Japan

A Comparison of Case Fatality Risk of COVID-19 between Singapore and Japan

Validating and modeling the impact of high-frequency rapid antigen screening on COVID-19 spread and outcomes

Validating and modeling the impact of high-frequency rapid antigen screening on COVID-19 spread and outcomes

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