Reconstructing the early global dynamics of under-ascertained COVID-19 cases and infections.
Reconstructing the early global dynamics of under-ascertained COVID-19 cases and infections.
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DOI：
10.1186/s12916-020-01790-9
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发表时间：
2020-10-22
期刊：
影响因子：
9.3
通讯作者：
CMMID COVID-19 working group
中科院分区：
文献类型：
--
作者：
Russell TW;Golding N;Hellewell J;Abbott S;Wright L;Pearson CAB;van Zandvoort K;Jarvis CI;Gibbs H;Liu Y;Eggo RM;Edmunds WJ;Kucharski AJ;CMMID COVID-19 working group
无症状或亚临床SARS-CoV-2感染通常未报告，这意味着确诊病例数可能无法准确反映潜在的流行动态。了解确诊水平（确诊的有症状病例与有症状个体的真实数量之比）和未被发现的疫情进展对于制定COVID-19应对计划（包括引入和放松控制措施）至关重要。随着时间的推移估计病例确定可以准确估计特定结果，如血清阳性率，这对规划控制措施至关重要。我们使用全球COVID-19病例和死亡病例的报告数据，估计了210个国家和地区报告的有症状病例（即发热≥ 37. 5 °C、咳嗽、呼吸急促、突然发作的嗅觉丧失、味觉丧失或味觉障碍疾病中的任何一种）的比例，因为这些国家已经经历了10例以上的死亡。我们使用已发表的基线病死率（CFR）估计值，对延迟和不确定性进行了调整，然后计算该基线CFR与估计的当地延迟调整CFR的比值，以估计特定位置的不确定性水平。然后，我们拟合贝叶斯高斯过程模型来估计不确定的时间模式。根据报告的病例和死亡人数，我们估计，在2020年3月期间，在84个国家中发现的有症状病例的中位百分比在2.4%（孟加拉国）至100%（智利）之间。在截至2020年7月6日确诊病例总数最多的10个国家中，我们估计有症状病例的峰值数量为报告数量的1.4倍（智利）至18倍（法国）。将我们的模型与国家和地区的血清阳性率数据进行比较，我们发现我们的估计值与观察值一致。最后，我们估计了每个国家的血清阳性率。截至6月7日，我们的血清阳性率估计值范围从0%（许多国家）到13%（95% CrI 5.6-24%）（比利时）。我们发现，在许多国家，特别是在SARS-CoV-2大流行的第一波高峰期，有症状的病例存在大量的不确定性。因此，报告的病例数可能会低估疫情初期的增长速度，并低估疫情后期的下降速度。虽然在许多地方存在相当大的漏报，但我们的估计与新出现的血清学数据一致，表明全球每个国家感染SARS-CoV-2的人口比例普遍较低。
Asymptomatic or subclinical SARS-CoV-2 infections are often unreported, which means that confirmed case counts may not accurately reflect underlying epidemic dynamics. Understanding the level of ascertainment (the ratio of confirmed symptomatic cases to the true number of symptomatic individuals) and undetected epidemic progression is crucial to informing COVID-19 response planning, including the introduction and relaxation of control measures. Estimating case ascertainment over time allows for accurate estimates of specific outcomes such as seroprevalence, which is essential for planning control measures. Using reported data on COVID-19 cases and fatalities globally, we estimated the proportion of symptomatic cases (i.e. any person with any of fever ≥ 37.5 °C, cough, shortness of breath, sudden onset of anosmia, ageusia or dysgeusia illness) that were reported in 210 countries and territories, given those countries had experienced more than ten deaths. We used published estimates of the baseline case fatality ratio (CFR), which was adjusted for delays and under-ascertainment, then calculated the ratio of this baseline CFR to an estimated local delay-adjusted CFR to estimate the level of under-ascertainment in a particular location. We then fit a Bayesian Gaussian process model to estimate the temporal pattern of under-ascertainment. Based on reported cases and deaths, we estimated that, during March 2020, the median percentage of symptomatic cases detected across the 84 countries which experienced more than ten deaths ranged from 2.4% (Bangladesh) to 100% (Chile). Across the ten countries with the highest number of total confirmed cases as of 6 July 2020, we estimated that the peak number of symptomatic cases ranged from 1.4 times (Chile) to 18 times (France) larger than reported. Comparing our model with national and regional seroprevalence data where available, we find that our estimates are consistent with observed values. Finally, we estimated seroprevalence for each country. As of 7 June, our seroprevalence estimates range from 0% (many countries) to 13% (95% CrI 5.6–24%) (Belgium). We found substantial under-ascertainment of symptomatic cases, particularly at the peak of the first wave of the SARS-CoV-2 pandemic, in many countries. Reported case counts will therefore likely underestimate the rate of outbreak growth initially and underestimate the decline in the later stages of an epidemic. Although there was considerable under-reporting in many locations, our estimates were consistent with emerging serological data, suggesting that the proportion of each country’s population infected with SARS-CoV-2 worldwide is generally low.
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影响因子：
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作者：
Abbott, Sam;Hellewell, Joel;Funk, Sebastian
通讯作者：
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DOI：
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发表时间：
2020-03-01
期刊：
Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin
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影响因子：
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DOI：
10.1016/s1473-3099(20)30243-7
发表时间：
2020-06-01
期刊：
The Lancet. Infectious diseases
影响因子：
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作者：
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