The prevalence of SARS-CoV-2 infection and other public health outcomes during the BA.2/BA.2.12.1 surge, New York City, April-May 2022

Abstract

ImportanceRoutine case surveillance data for SARS-CoV-2 are incomplete, biased, missing key variables of interest, and may be unreliable for both timely surge detection and understanding the burden of infection.ObjectiveTo determine the prevalence of SARS-CoV-2 infection during the Omicron BA.2/BA.2.12.1 surge in relation to official case counts, and to assess the epidemiology of infection and uptake of SARS-CoV-2 antivirals.DesignCross-sectional survey of a representative sample of New York City (NYC) adult residents, conducted May 7-8, 2022.SettingNYC, April 23-May 8, 2022, during which the official SARS-CoV-2 case count was 49,253 and BA.2.12.2 comprised 20% of reported cases.ParticipantsA representative sample of 1,030 NYC adult residents >18 years.Exposure(s)Vulnerability to severe COVID-19, including vaccination/booster status, prior COVID, age, and presence of comorbidities.Main Outcome(s) and Measure(s)Prevalence of SARS-CoV-2 infection during a 14-day period, weighted to represent the NYC adult population. Respondents self-reported on SARS-CoV-2 testing (including at-home rapid antigen tests), testing outcomes, COVID-like symptoms, and contact with confirmed/probable cases. Individuals with SARS-CoV-2 were asked about awareness/use of antiviral medications.ResultsAn estimated 22.1% (95%CI 17.9%-26.2%) of respondents had SARS-CoV-2 infection during the study period, corresponding to ∼1.5 million adults (95%CI 1.3-1.8 million). Prevalence was estimated at 34.9% (95%CI 26.9%-42.8%) among individuals with co-morbidities, 14.9% (95% CI 11.0%-18.8%) among those 65+ years, and 18.9% (95%CI 10.2%-27.5%) among unvaccinated persons. Hybrid protection against severe disease (i.e., from both vaccination and prior infection) was 66.2% (95%CI 55.7%-76.7%) among those with COVID and 46.3% (95%CI 40.2-52.2) among those without. Among individuals with COVID, 55.9% (95%CI 44.9%-67.0%) were not aware of the antiviral nirmatrelvir/ritonavir (Paxlovid™), and 15.1% (95%CI 7.1%-23.1%) reported receiving it.Conclusions and RelevanceThe true magnitude of NYC’s BA.2/BA.2.12.1 surge was vastly underestimated by routine SARS-CoV-2 surveillance. Until there is more certainty that the impact of future pandemic surges on severe population health outcomes will be diminished, representative surveys are needed for timely surge detection, and to estimate the true burden of infection, hybrid protection, and uptake of time-sensitive treatments.

Comparison of COVID-19 home-testers vs. laboratory-testers in New York State (excluding New York City), November 2021 to April 2022

“…This study fills a gap in the literature by examining the association between testing groups and vaccination choices by utilizing vaccine registries (in contrast to self-reporting) to obtain vaccine histories for all three testing groups. Overall trend in home-testing vs laboratory-based testing as well as race, ethnicity and vaccination status differences between testing groups observed in this study is consistent with that reported in survey-based studies ( 9 , 12 , 13 , 17 ) and could be compared with each other. This study demonstrates that certain populations are more likely to use only home tests.…”

“…Official reports and other analyses were primarily based on laboratory-based testing, as home tests were not typically included in data systems that track COVID-19 cases and rates. Consequently, there was a dearth of information on home test usage and users; the research available on this topic is limited to surveys that have a higher risk of response bias and were conducted on adults ( 12 , 13 ). Given this fact, there is a critical need to better understand individuals, including children, who use and report home tests, as well as the trends in home testing.…”

Comparison of COVID-19 Home-Testers vs Laboratory-Testers in New York State (Excluding New York City), November 2021 to April 2022

“…The strengths of this study include the analysis of tests during the Omicron period with widespread home testing coverage and population-based large sample sizes using case investigation data collected by trained interviewers, as opposed to survey data impacted by response bias. However, testing trends as well as demographic (age, race) and vaccination status observed were consistent with survey-based studies (9, 12, 13, 17) and were able to validate each other. This study demonstrated that certain populations are more likely to use home tests only.…”

“…Official reporting, as well as other analytics, are primarily based on laboratory-based testing, as home tests are not typically reported to data systems tracking COVID-19 case volume and rates. Consequently, there is a dearth of information on home test usage and users; studies available are very few, survey-based with an associated response bias and are on adults (12, 13). Given this scenario, there is a critical need to better understand the individuals, including children, using and reporting home tests, as well as trends in home tests.…”

The prevalence of SARS-CoV-2 infection and long COVID in US adults during the BA.5 surge, June-July 2022

“…Similar to prior findings using the same methodology 17,18 , we estimated a higher prevalence of SARS-CoV-2 infection among those who were vaccinated and boosted compared with those who were fully vaccinated but not boosted and those who were unvaccinated. Since vaccines and boosters provide limited protection against infection with omicron variants compared with prior strains 19 , these differences are likely due to differences in SARS-CoV-2 exposures and health behaviors between the two groups.…”