dc.contributor.author	Lu, Fred S.
dc.contributor.author	Nguyen, Andre T.
dc.contributor.author	Link, Nicholas B.
dc.contributor.author	Molina, Mathieu
dc.contributor.author	Davis, Jessica T.
dc.contributor.author	Chinazzi, Matteo
dc.contributor.author	Xiong, Xinyue
dc.contributor.author	Vespignani, Alessandro
dc.contributor.author	Lipsitch, Marc
dc.contributor.author	Santillana, Mauricio
dc.date.accessioned	2021-07-06T15:20:45Z
dc.date.available	2021-07-06T15:20:45Z
dc.date.issued	2021-06-17
dc.description.abstract	Effectively designing and evaluating public health responses to the ongoing COVID-19 pandemic requires accurate estimation of the prevalence of COVID-19 across the United States (US). Equipment shortages and varying testing capabilities have however hindered the usefulness of the official reported positive COVID-19 case counts. We introduce four complementary approaches to estimate the cumulative incidence of symptomatic COVID-19 in each state in the US as well as Puerto Rico and the District of Columbia, using a combination of excess influenza-like illness reports, COVID-19 test statistics, COVID-19 mortality reports, and a spatially structured epidemic model. Instead of relying on the estimate from a single data source or method that may be biased, we provide multiple estimates, each relying on different assumptions and data sources. Across our four approaches emerges the consistent conclusion that on April 4, 2020, the estimated case count was 5 to 50 times higher than the official positive test counts across the different states. Nationally, our estimates of COVID-19 symptomatic cases as of April 4 have a likely range of 2.3 to 4.8 million, with possibly as many as 7.6 million cases, up to 25 times greater than the cumulative confirmed cases of about 311,000. Extending our methods to May 16, 2020, we estimate that cumulative symptomatic incidence ranges from 4.9 to 10.1 million, as opposed to 1.5 million positive test counts. The proposed combination of approaches may prove useful in assessing the burden of COVID-19 during resurgences in the US and other countries with comparable surveillance systems.	en_US
dc.description.sponsorship	MS and AV are partially supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number R01GM130668. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.	en_US
dc.description.uri	https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1008994	en_US
dc.format.extent	7 files	en_US
dc.genre	journal articles postprints	en_US
dc.identifier	doi:10.13016/m23lvr-qnlj
dc.identifier.citation	Lu, Fred S. et al.; Estimating the cumulative incidence of COVID-19 in the United States using influenza surveillance, virologic testing, and mortality data: Four complementary approaches; PLoS Computational Biology, 17,6, 17 June, 2021; https://doi.org/10.1371/journal.pcbi.1008994	en_US
dc.identifier.uri	https://doi.org/10.1371/journal.pcbi.1008994
dc.identifier.uri	http://hdl.handle.net/11603/21859
dc.language.iso	en_US	en_US
dc.publisher	PLOS	en_US
dc.relation.isAvailableAt	The University of Maryland, Baltimore County (UMBC)
dc.relation.ispartof	UMBC Computer Science and Electrical Engineering Department Collection
dc.relation.ispartof	UMBC Student Collection
dc.rights	This item is likely protected under Title 17 of the U.S. Copyright Law. Unless on a Creative Commons license, for uses protected by Copyright Law, contact the copyright holder or the author.
dc.rights	Public Domain Mark 1.0	*
dc.rights	This work was written as part of one of the author's official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 U.S.C. 105, no copyright protection is available for such works under U.S. Law.
dc.rights.uri	http://creativecommons.org/publicdomain/mark/1.0/	*
dc.title	Estimating the cumulative incidence of COVID-19 in the United States using influenza surveillance, virologic testing, and mortality data: Four complementary approaches	en_US
dc.type	Text	en_US

Estimating the cumulative incidence of COVID-19 in the United States using influenza surveillance, virologic testing, and mortality data: Four complementary approaches

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