SARS-CoV-2 Cumulative Incidence and Period Seroprevalence: Results From a Statewide Population-Based Serosurvey in California

Author:

Lamba Katherine1,Bradley Heather2,Shioda Kayoko3,Sullivan Patrick S4,Luisi Nicole4,Hall Eric W4,Mehrotra Megha L1,Lim Esther1,Jain Seema1ORCID,Kamali Amanda1,Sanchez Travis4,Lopman Benjamin A4,Fahimi Mansour5,Siegler Aaron J4ORCID

Affiliation:

1. California Department of Public Health, Richmond, California, USA

2. Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA

3. Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA

4. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA

5. Marketing Systems Group, Horsham, Pennsylvania, USA

Abstract

Abstract Background California has reported the largest number of coronavirus disease 2019 (COVID-19) cases of any US state, with more than 3.5 million confirmed as of March 2021. However, the full breadth of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in California is unknown as reported cases only represent a fraction of all infections. Methods We conducted a population-based serosurvey, utilizing mailed, home-based SARS-CoV-2 antibody testing along with a demographic and behavioral survey. We weighted data from a random sample to represent the adult California population and estimated period seroprevalence overall and by participant characteristics. Seroprevalence estimates were adjusted for waning antibodies to produce statewide estimates of cumulative incidence, the infection fatality ratio (IFR), and the reported fraction. Results California’s SARS-CoV-2 weighted seroprevalence during August–December 2020 was 4.6% (95% CI, 2.8%–7.4%). Estimated cumulative incidence as of November 2, 2020, was 8.7% (95% CrI, 6.4%–11.5%), indicating that 2 660 441 adults (95% CrI, 1 959 218–3 532 380) had been infected. The estimated IFR was 0.8% (95% CrI, 0.6%–1.0%), and the estimated percentage of infections reported to the California Department of Public Health was 31%. Disparately high risk for infection was observed among persons of Hispanic/Latinx ethnicity and people with no health insurance and who reported working outside the home. Conclusions We present the first statewide SARS-CoV-2 cumulative incidence estimate among adults in California. As of November 2020, ~1 in 3 SARS-CoV-2 infections in California adults had been identified by public health surveillance. When accounting for unreported SARS-CoV-2 infections, disparities by race/ethnicity seen in case-based surveillance persist.

Funder

Centers for Disease Control and Prevention

Epidemiology and Laboratory Capacity for Infectious Diseases

National Institute of Allergy and Infectious Diseases

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Oncology

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