¿Cómo ha llevado la falta de disponibilidad de tests a un subregistro de la verdadera incidencia del Covid-19?

(How has lack of testing availability led to underreporting of true incidence of covid-19?)

Primeras 5 respuestas:

lack of widespread access to testing for COVID-19 are likely to have resulted in under-estimation of COVID-19 mortality.

As of March 16, a total of 4,226 COVID-19 cases in the United States had been reported to CDC,

We further investigate the sensitivity to various degrees of potential underreporting on the estimates.

In the absence of testing availability and confirmation, accurate case estimations for this period of the outbreak may never be known.

A further limitation is that we lacked data on transfers of critically ill patients from rural areas to facilities in large urban areas.

lack of widespread access to testing for COVID-19 are likely to have resulted in under-estimation of COVID-19 mortality.

... deaths related to COVID-19. Both of these conditions make patients more susceptible to infection and lack of widespread access to testing for COVID-19 are likely to have resulted in under-estimation of COVID-19 mortality. These data further suggest that the cumulative toll of COVID-19 on mortality is likely undercounted. ...

Ref: Trends in excess cancer and cardiovascular deaths in Scotland during the COVID-19 pandemic 30 December 2019 to 20 April 2020 [J Med Virol, 2020-05-06]

As of March 16, a total of 4,226 COVID-19 cases in the United States had been reported to CDC,

... disease (hospitalization, admission to intensive care unit [ICU], and death) were analyzed by age group. As of March 16, a total of 4,226 COVID-19 cases in the United States had been reported to CDC, with multiple cases reported among older adults living in long-term care facilities (4). Overall, 31% ...

Ref: Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. [MMWR. Morbidity and mortality weekly report, 2020-03-27]

We further investigate the sensitivity to various degrees of potential underreporting on the estimates.

... and suppression. We estimate the timelines of incidence, hospitalization rates, the intensive care (ICU) need, and the mortality in relation to the current Swedish ICU capacity, and costs of care. We further investigate the sensitivity to various degrees of potential underreporting on the estimates. ...

Ref: Covid-19 health care demand and mortality in Sweden in response to non-pharmaceutical (NPIs) mitigation and suppression scenarios [MMWR. Morbidity and mortality weekly report, 2020-03-23]

In the absence of testing availability and confirmation, accurate case estimations for this period of the outbreak may never be known.

... testing, and mentions of recovery related to COVID-19. Many users reported symptoms they thought were related to COVID-19, but they were not able to get tested to confirm their concerns. In the absence of testing availability and confirmation, accurate case estimations for this period of the outbreak may never be known. ...

Ref: Machine Learning to Detect Self-Reporting of Symptoms, Testing Access, and Recovery Associated With COVID-19 on Twitter: Retrospective Big Data Infoveillance Study [JMIR Public Health Surveill, 2020]

A further limitation is that we lacked data on transfers of critically ill patients from rural areas to facilities in large urban areas.

... pandemic. However, urban centers may be more equipped to increase their critical care capacity than rural centers. A further limitation is that we lacked data on transfers of critically ill patients from rural areas to facilities in large urban areas. ...

Ref: Epidemiology of the 2020 pandemic of COVID‐19 in the state of Georgia: Inadequate critical care resources and impact after 7 weeks of community spread [J Am Coll Emerg Physicians Open, 2020-05-26]

I address that critique by fitting a generalized additive model to weekly counts of all deaths registered in England and Wales during the 2010s.

... for potentially including people who did not die of COVID-19 but merely died with COVID-19. I address that critique by fitting a generalized additive model to weekly counts of all deaths registered in England and Wales during the 2010s. The model produces baseline rates of death registrations expected without the COVID-19 pandemic, and comparing ...

Ref: Excess registered deaths in England and Wales during the COVID-19 pandemic, March 2020 to May 2020 [J Am Coll Emerg Physicians Open, 2020-04-23]

Our data support concerns about massively insufficient testing in many global COVID-19 epicenters compared to Germany and South Korea.

... Our data support concerns about massively insufficient testing in many global COVID-19 epicenters compared to Germany and South Korea. If we assume that mortality rates are roughly stable, COVID-19 related mortality numbers might serve as a better indicator than case numbers to grasp the extent of COVID-19 spread. However, ...

Ref: Evaluating the massive underreporting and undertesting of COVID-19 cases in multiple global epicenters [Pulmonology, 2020-06-06]

many countries either lack testing kits and infrastructure, fear associated expenses or that cultural factors may impede virus' detection [1 -4] .

... the same time, concerns have been voiced that COVID-19 testing has been insufficient and that many countries either lack testing kits and infrastructure, fear associated expenses or that cultural factors may impede virus" detection [1 -4] . Once patients are hospitalized, their symptoms are described as flu-like, and their condition often deteriorates ...

Ref: Evaluating the massive underreporting and undertesting of COVID-19 cases in multiple global epicenters [Pulmonology, 2020-06-06]

County-level comparisons can both inform COVID-19 responses and identify epidemic hot spots.

... black and they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally. County-level comparisons can both inform COVID-19 responses and identify epidemic hot spots. Social conditions, structural racism, and other factors elevate risk for COVID-19 diagnoses and deaths in ...

Ref: Assessing Differential Impacts of COVID-19 on Black Communities [Ann. epidemiol, 2020]

It remains challenging to distinguish the effect of different measures due to a lack of testing kits, insufficient detection, and varying containment policies.

... waves can be experienced for many months. [13] [14] [15] Limitations of this study include the quality of provided case numbers, as they might be subject to bias and underreporting. It remains challenging to distinguish the effect of different measures due to a lack of testing kits, insufficient detection, and varying containment policies. ...

Ref: Failure in initial stage containment of global COVID‐19 epicenters [J Med Virol, 2020-04-28]

Lack of full capture of lab results may continue to be a challenge as the variety of available tests expands.

... criteria, and 71 (47.3%) had evidence of a positive lab result from an outside source. Lack of full capture of lab results may continue to be a challenge as the variety of available tests expands. Administrative data may provide an important stopgap measure for detecting lab positive cases, pending incorporation ...

Ref: Special report: Early use of ICD-10-CM code "U07.1, COVID-19" to identify 2019 novel coronavirus cases in Military Health System administrative data. [MSMR, 2020-05-01]

We cannot exclude endogenous factors such as testing, that affect the relationship between the BCG vaccine and number of COVID-19 attributable cases and mortality.

... before making assertions on how BCG vaccinations influence the emergence of COVID-19-related cases and deaths. We cannot exclude endogenous factors such as testing, that affect the relationship between the BCG vaccine and number of COVID-19 attributable cases and mortality. We argue that it may be beneficial to create a longitudinal study that can be ...

Ref: Is there evidence that BCG vaccination has non-specific protective effects for COVID 19 infections or is it an illusion created by lack of testing? [MSMR, 2020-04-23]

Retrospective testing for COVID-19 of samples from influenza-like-illness surveillance found no positive test among children,

... of infection in younger individuals. The reason for this age shift is unknown [10] . Retrospective testing for COVID-19 of samples from influenza-like-illness surveillance found no positive test among children, but the sample sizes were small (20 per week including both adults and children) [10] ...

Ref: Estimation of SARS-CoV-2 mortality during the early stages of an epidemic: a modelling study in Hubei, China and northern Italy [MSMR, 2020-03-06]

Of the ones that have so far been tested, how many have developed severe disease and how many were tested positive but showed no clinical sign of disease?

... been reported; is this due to lack of testing or a true lack of infection/susceptibility? Of the ones that have so far been tested, how many have developed severe disease and how many were tested positive but showed no clinical sign of disease? There are some basic questions that would provide a framework for which more specific and ...

Ref: The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak [J Autoimmun, 2020-02-26]

The low numbers could in part be related to limited testing due to limited resources dedicated to diagnostics.

... underpinning the apparent low number of COVID-19 cases in settings with parasitic-infection endemicity is multifactorial. The low numbers could in part be related to limited testing due to limited resources dedicated to diagnostics. For example, data from Uganda shows 47,620 tests have been performed with 100 confirmed cases ...

Ref: Parasites and their protection against COVID-19- Ecology or Immunology? [J Autoimmun, 2020-05-18]

The study findings show how covid-19 can have a considerable impact on the health of a small community.

... to about half of the 166 deaths from all causes observed in that period. CONCLUSIONS: The study findings show how covid-19 can have a considerable impact on the health of a small community. Furthermore, the results suggest that the full implications of the covid-19 pandemic can only be ...

Ref: Use of all cause mortality to quantify the consequences of covid-19 in Nembro, Lombardy: descriptive study [BMJ, 2020-05-14]

Quantification of case reporting can provide a more accurate measure of the virulence and disease burden of severe acute respiratory syndrome coronavirus 2.

... COVID-19 in Canada is likely to be less than 2%. The CFR estimates for the US were higher than those for Canada, but the adjusted CFR still remained below 2%. Quantification of case reporting can provide a more accurate measure of the virulence and disease burden of severe acute respiratory syndrome coronavirus 2. ...

Ref: Temporal estimates of case-fatality rate for COVID-19 outbreaks in Canada and the United States [CMAJ, 2020]

These data further suggest that the cumulative toll of COVID-19 on mortality is likely undercounted.

... access to testing for COVID-19 are likely to have resulted in under-estimation of COVID-19 mortality. These data further suggest that the cumulative toll of COVID-19 on mortality is likely undercounted. More detailed analysis is needed to determine if these excesses were directly or indirectly related ...

Ref: Trends in excess cancer and cardiovascular deaths in Scotland during the COVID-19 pandemic 30 December 2019 to 20 April 2020 [CMAJ, 2020-05-06]

There are no conflicts to declare.

socioeconomic bias in testing suggests that the number of confirmed case counts may substantially underestimate the true number of cases in the population.

... Together with changes in surveillance guidelines, socioeconomic bias in testing suggests that the number of confirmed case counts may substantially underestimate the true number of cases in the population. Additional reasons for underreporting include (i) a significant proportion of asymptomatic infections 15 , (ii) people with mild and even moderate disease are unlikely ...

Ref: Epidemiological and clinical characteristics of the early phase of the COVID-19 epidemic in Brazil [J Am Coll Emerg Physicians Open, 2020-04-29]

The RT-PCR test was performed on 338,000 patients.

... 12,877 laboratory-confirmed COVID-19 cases were registered in Poland (55.7% women, mean age 50.6 (20.5) years). The RT-PCR test was performed on 338,000 patients. The notification rate for COVID-19 was 33.2 per 100,000 inhabitants. One-third of laboratory-confirmed COVID-19 cases ...

Ref: Dynamics of COVID-19 outbreak in Poland: an epidemiological analysis of the first two months of the epidemic. [Polish archives of internal medicine, 2020-06-10]

Lack of universal testing and death underreporting make between-country comparisons difficult.

... Background: Reported death rates from different countries during the COVID-19 pandemic vary. Lack of universal testing and death underreporting make between-country comparisons difficult. The country-level determinants of COVID-19 mortality are unknown. Objective: Derive a measure of COVID-related death rates that is ...

Ref: Number of International Arrivals Predicts Severity of the first Global Wave of the COVID-19 Pandemic [Polish archives of internal medicine, 2020-05-16]

due to the relatively low testing rate in the U.S., the daily incidence and deaths may be underestimated.

... by the retrospective nature of the modeling part, and may have some related biases. Moreover, due to the relatively low testing rate in the U.S., the daily incidence and deaths may be underestimated. Our sensitivity study using the 1.3 acres data, however, confirms a similar correlation off and ...

Ref: Trends and prediction in daily incidence and deaths of COVID-19 in the United States: a search-interest based model [medRxiv, 2020-04-20]

Official counts of COVID-19 deaths have been criticized for potentially including people who did not die of COVID-19

... Official counts of COVID-19 deaths have been criticized for potentially including people who did not die of COVID-19 but merely died with COVID-19. I address that critique by fitting a generalized additive model to weekly counts of all deaths registered in England and Wales during the 2010s. The ...

Ref: Excess registered deaths in England and Wales during the COVID-19 pandemic, March 2020 to May 2020 [medRxiv, 2020-04-23]

5 Even in countries with widespread testing, the mortality burden of COVID-19 is more appropriately measured by age-specific mortality rates.

... denominator of the case fatality rate) in most countries due to a lack of testing. 5 Even in countries with widespread testing, the mortality burden of COVID-19 is more appropriately measured by age-specific mortality rates. In contrast to case fatality rates, mortality rates are computed by dividing deaths due to ...

Ref: Population-Level Mortality Rates from Novel Coronavirus (COVID-19) in South Korea [medRxiv : the preprint server for health sciences, 2020-03-27]

Moreover, due to the relatively low testing rate in the U.S., the daily incidence and deaths may be underestimated.

... limited by the retrospective nature of the modeling part, and may have some related biases. Moreover, due to the relatively low testing rate in the U.S., the daily incidence and deaths may be underestimated. Our sensitivity study using the 1.3 acres data, however, confirms a similar correlation off and ...

Ref: Trends and prediction in daily incidence and deaths of COVID-19 in the United States: a search-interest based model [medRxiv, 2020-04-20]

In absence of extensive testing for SARS-CoV-2, true prevalence of COVID-19 cases in India remain unknown.

... In absence of extensive testing for SARS-CoV-2, true prevalence of COVID-19 cases in India remain unknown. In this study, a conservative estimate of prevalence of COVID-19 is calculated based on the age wise COVID-19 positivity rate among patients with severe respiratory illness as reported by Indian ...

Ref: Estimate of COVID-19 case prevalence in India based on surveillance data of patients with severe acute respiratory illness [medRxiv, 2020-04-17]

Testing in representative samples in different settings could help assess the true prevalence of infection, and would reduce uncertainty of modelling assumptions.

... best possible balance of measures, decision makers must constantly monitor the outbreak situation and the impact of the measures implemented. Testing in representative samples in different settings could help assess the true prevalence of infection, and would reduce uncertainty of modelling assumptions. This review was commissioned by WHO and supported by Danube-University-Krems. ...

Ref: Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. [The Cochrane database of systematic reviews, 2020-04-08]

an overestimation of spread may lead to disproportionate measures being taken, causing avoidable strain on livelihoods and economies.

... limited resources are not deployed to maximum effect. In the absence of extensive testing data, an overestimation of spread may lead to disproportionate measures being taken, causing avoidable strain on livelihoods and economies. Here, based on the African situation, we discuss COVID-19 diagnostic challenges and how they may ...

Ref: COVID-19: Are Africa’s diagnostic challenges blunting response effectiveness? [AAS Open Res, 2020-04-17]

fear associated expenses or that cultural factors may impede virus' detection [1 -4] .

... COVID-19 testing has been insufficient and that many countries either lack testing kits and infrastructure, fear associated expenses or that cultural factors may impede virus" detection [1 -4] . Once patients are hospitalized, their symptoms are described as flu-like, and their condition often deteriorates ...

Ref: Evaluating the massive underreporting and undertesting of COVID-19 cases in multiple global epicenters [Pulmonology, 2020-06-06]

CONCLUSIONS: The study findings show how covid-19 can have a considerable impact on the health of a small community.

... corresponding to about half of the 166 deaths from all causes observed in that period. CONCLUSIONS: The study findings show how covid-19 can have a considerable impact on the health of a small community. Furthermore, the results suggest that the full implications of the covid-19 pandemic can only be ...

Ref: Use of all cause mortality to quantify the consequences of covid-19 in Nembro, Lombardy: descriptive study [BMJ, 2020-05-14]

Our study was limited by the availability of data from pregnant women with COVID-268 19.

... mechanistic model could provide a better insight into possibility and prediction of future 267 outbreaks. Our study was limited by the availability of data from pregnant women with COVID-268 19. We encourage obstetrical care providers nationally to participate in registries for pregnant 269 women affected ...

Ref: Forecasting the Impact of Coronavirus Disease During Delivery Hospitalization: An Aid for Resources Utilization [Am J Obstet Gynecol MFM, 2020-04-25]

The true incidence of pediatric infection and disease will only be known once testing is expanded to individuals with less severe or no symptoms.

... 318). Death was reported for 15 cases. CONCLUSION: Children accounted for 1.9% of confirmed cases. The true incidence of pediatric infection and disease will only be known once testing is expanded to individuals with less severe or no symptoms. Admission rates vary from 0.3 to 10% of confirmed cases (presumably varying with the threshold ...

Ref: COVID- 19 Infection in Children: Estimating Pediatric Morbidity and Mortality [Am J Obstet Gynecol MFM, 2020-05-08]

Almost half of patients (47%) with COVID-19 reported lack of appetite and 24.2% reported diarrhea.

... of patients with COVID-19. At least one gastrointestinal symptom was reported by 53.6% of patients. Almost half of patients (47%) with COVID-19 reported lack of appetite and 24.2% reported diarrhea. Among 1,942 interviewed patients, 54.2% reported at least one olfactory or taste disorder and 42.5% ...

Ref: Gender differences in the frequency of gastrointestinal symptoms and olfactory or taste disorders among 1,942 non-hospitalized patients with COVID-19 [Pol. Arch. Med. Wew. (Online), 2020]

5) diagnostic testing capacity; and 6) public health reporting practices.

... medical conditions among COVID-19 patients (1-3); 4) the timing and extent of community mitigation measures; 5) diagnostic testing capacity; and 6) public health reporting practices. Monitoring jurisdiction-level numbers of COVID-19 cases, deaths, and changes in incidence is critical for understanding ...

Ref: Geographic Differences in COVID-19 Cases, Deaths, and Incidence - United States, February 12-April 7, 2020. [MMWR. Morbidity and mortality weekly report, 2020-04-17]

Testing rates over the past week have increased markedly, with a continued very low proportion of people testing positive.

... have likely been effective in slowing the spread of the disease, in the Australian community. Testing rates over the past week have increased markedly, with a continued very low proportion of people testing positive. These low rates of detection are indicative of low levels of COVID-19 transmission. It is ...

Ref: COVID-19, Australia: Epidemiology Report 16 (Reporting week to 23:59 AEST 17 May 2020). [Communicable diseases intelligence, 2020-05-22]

Underreporting of the incidence of COVID-19 could lead to a false sense of security among rural populations

... 1-4 current testing policies may be failing to detect asymptomatic cases at an effective rate. Underreporting of the incidence of COVID-19 could lead to a false sense of security among rural populations and lead to neglect of safety guidelines recommended by the CDC. 18 Granted, case counts ...

Ref: A Commentary on Rural‐Urban Disparities in COVID‐19 Testing Rates per 100,000 and Risk Factors [J Rural Health, 2020-04-13]

before any modeling purpose we have the desire to correct and update the current numbers, bringing them as close as possible to reality.

... Faced with the lack of COVID-19 tests, which naturally leads to the underreporting data, before any modeling purpose we have the desire to correct and update the current numbers, bringing them as close as possible to reality. ...

Ref: Bayesian modeling of COVID-19 cases with a correction to account for under-reported cases [J Rural Health, 2020-05-25]

Hospitalized Patients National data on frequency of hospitalization of infected patients is lacking as of this publication due to inconsistent reporting methods.

... Hospitalized Patients National data on frequency of hospitalization of infected patients is lacking as of this publication due to inconsistent reporting methods. Individual states, however, report similar hospitalization rates via The COVID Tracking Project, revealing rates ranging from 8-24% with higher hospitalization frequency correlating directly with age(7). Of those who were sick ...

Ref: Prognostication and Proactive Planning in COVID-19 [J Pain Symptom Manage, 2020-05-07]

resident was unable/unwilling to complete testing or was isolated awaiting results.

... cases were those with "detected" SARS-CoV-2 infection by Real-Time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) testing on nasopharyngeal swabs. Suspected cases were based on senior medical/nursing opinion of COVID-19 symptoms, but resident was unable/unwilling to complete testing or was isolated awaiting results. ...

Ref: Asymptomatic carriage rates and case-fatality of SARS-CoV-2 infection in residents and staff in Irish nursing homes [J Pain Symptom Manage, 2020-06-12]

Steroid therapy was extensively tested in the treatment of severe SARS-1, and proved of no benefit, and possibly produced harm.

... Steroid therapy was extensively tested in the treatment of severe SARS-1, and proved of no benefit, and possibly produced harm. SARS-1 notably produced severe inflammation, with high levels of IL-6, TNF-ɑ, interferons, and multi-organ system failure, and case reports suggest patients with this level of inflammation are benefitting from anti-IL6 ...

Ref: The Risk of SARS-CoV-2 in Immunosuppressed IBD Patients [Crohns Colitis 360, 2020-04-16]

Therefore we use the total number of active cases (confirmed -recovered -deaths) as a proxy for the total number of infected individuals.

... preprint this version posted May 6, 2020. . limited testing availability and potential testing errors. Therefore we use the total number of active cases (confirmed -recovered -deaths) as a proxy for the total number of infected individuals. In countries with sufficient testing, we assume that the identified active cases represent a constant ...

Ref: Time-adjusted Analysis Shows Weak Associations Between BCG Vaccination Policy and COVID-19 Disease Progression [Crohns Colitis 360, 2020-05-06]

Relatively lower numbers of reported COVID-19 infections in a county, is also been attributed to less number of tests being conducted,

Relatively lower numbers of reported COVID-19 infections in a county, is also been attributed to less number of tests being conducted, as the case for several Asian and African

Ref: Comparative analyses revealed reduced spread of COVID-19 in malaria endemic countries [Crohns Colitis 360, 2020-05-14]

This is compounded by testing policies that restrict access to testing in most countries, and test delays caused by insufficient testing capacities.

... much as 50 to 100. This rather large factor arises primarily from the rapid growth of the epidemic and the delays between infection, symptom onset, testing, and reporting of results. This is compounded by testing policies that restrict access to testing in most countries, and test delays caused by insufficient testing capacities. ...

Ref: Severe underestimation of COVID-19 case numbers: effect of epidemic growth rate and test restrictions [Crohns Colitis 360, 2020-04-17]

Despite the underreporting of coronavirus cases by government agencies across the country, the State of Sao Paulo has the highest rate among all Brazilian States.

... the number of deaths and people infected by COVID-19 in Brazil have been steadily increasing. Despite the underreporting of coronavirus cases by government agencies across the country, the State of Sao Paulo has the highest rate among all Brazilian States. Thus, it is essential to detect which areas contain the highest concentration of COVID-19 to ...

Ref: Applying a Prospective Space-Time Scan Statistic to Examine the Evolution of COVID-19 Clusters in the State of Sao Paulo, Brazil [Crohns Colitis 360, 2020-06-05]

We reported on the hospital critical care infrastructure by county using the number of ICU beds and primary care physicians as proxies.

... of county-level incidence rates are both a function of true incidence and more widespread testing. We reported on the hospital critical care infrastructure by county using the number of ICU beds and primary care physicians as proxies. We were unable to account for the number of available ventilator supplies. Additionally, hospital critical ...

This requires more vigilance for the next weeks during the gradual easing of the preventive measures.

... the under estimation of the actual burden of the epidemic is probably due to the lack of testing capacities, however, all the indicators show that the situation is currently controlled. This requires more vigilance for the next weeks during the gradual easing of the preventive measures. ...

Ref: Time Course of COVID-19 epidemic in Algeria: Retrospective estimate of the actual burden [J Am Coll Emerg Physicians Open, 2020-06-18]

Shortage of COVID‐19 tests was reported by 42.5%.

... donor liver by 73.3%; more stringent restrictions were associated with higher regional incidence of COVID‐19. Shortage of COVID‐19 tests was reported by 42.5%. Respondents reported a total of 148 COVID‐19 recipients from <1 to >10 years posttransplant: 69.6% ...

Ref: Early impact of COVID‐19 on transplant center practices and policies in the United States [Am J Transplant, 2020-05-10]

If the test turns out negative, it is advised to remain in home quarantine for 14 days.

... symptoms must undergo polymerase chain reaction (PCR) test and, if positive, be isolated and treated. If the test turns out negative, it is advised to remain in home quarantine for 14 days. People who are exposed to the virus but do not show any symptoms must remain ...

Ref: An Epidemiological Study on COVID-19: A Rapidly Spreading Disease [Cureus, 2020-03-18]

Deliberate attention to race and socio-economic barriers is needed when determining the locations of testing sites,

... an important step to more rapidly and completely describing health inequities and informing programs. 42 Deliberate attention to race and socio-economic barriers is needed when determining the locations of testing sites, yet an analysis in Philadelphia, where black people are a plurality of the population, found ...

Ref: Assessing Differential Impacts of COVID-19 on Black Communities [Cureus, 2020-05-08]

most states recommended that only those with a history of travel to affected countries or known contact with a confirmed case be tested (4, 5) .

... people in New York (12) . Due to the limited availability of tests early on, most states recommended that only those with a history of travel to affected countries or known contact with a confirmed case be tested (4, 5) . Since the disease has become more widespread throughout the US and testing capacity has increased, ...

Ref: The impact of changes in diagnostic testing practices on estimates of COVID-19 transmission in the United States [medRxiv, 2020-04-24]

limited diagnostic testing capacity during the early epidemic phase.

... COVID-19 incidence, we illustrate how epidemic curves of reported cases may not always reflect the true epidemic growth rate due to changes in testing rates, which could be influenced by limited diagnostic testing capacity during the early epidemic phase. ...

Ref: Changes in testing rates could mask the novel coronavirus disease (COVID-19) growth rate [Int J Infect Dis, 2020]

Our divergence analysis approach does not rely on any COVID-19 testing data and therefore may provide more accurate estimates in Washington.

... similar across methods than in Washington. Since Washington had already experienced an outbreak by February 28 [23] , testing shortages may have been more pronounced than in the other states. Our divergence analysis approach does not rely on any COVID-19 testing data and therefore may provide more accurate estimates in Washington. ...

Ref: Estimating the Prevalence of COVID-19 in the United States: Three Complementary Approaches [Int J Infect Dis, 2020-04-23]

Insufficient access to testing supplies and reagents highlights the need to selectively restrict test kit usage to a relatively limited number of individuals.

... paramount to controlling its spread. Currently, the availability of COVID-19 testing remains a limited resource. Insufficient access to testing supplies and reagents highlights the need to selectively restrict test kit usage to a relatively limited number of individuals. Many patients, including healthcare workers, are not tested as they do not meet "testing criteria" ...

Ref: Smell and taste symptom‐based predictive model for COVID‐19 diagnosis [Int Forum Allergy Rhinol, 2020-05-04]

We were unable to account for the number of available ventilator supplies.

... infrastructure by county using the number of ICU beds and primary care physicians as proxies. We were unable to account for the number of available ventilator supplies. Additionally, hospital critical care infrastructure is not static, and hospitals may have the capacity to ...

Given current testing criteria, many patients lacked COVID-19 testing access.

... were laboratory-confirmed COVID-19 positive, and 20 others (6%) were close contacts of confirmed COVID-19 cases. Given current testing criteria, many patients lacked COVID-19 testing access. For 55% of patients, pernio-like lesions were their only symptom. In patients with other COVID-19 ...

Ref: Pernio-like skin lesions associated with COVID-19: a case series of 318 patients from 8 countries [J. Am. Acad. Dermatol, 2020]

In many countries, confirmation of disease is based on clinical characteristics and CT findings and not on possible exposure and laboratory confirmation.

... In many countries, confirmation of disease is based on clinical characteristics and CT findings and not on possible exposure and laboratory confirmation. Many COVID-19 carriers therefore remain undetected, while HCPs on the frontlines face a high risk of contracting the disease. This includes HCPs working without sufficient PPE in ordinary departments where ...

Ref: COVID-19 pandemic, healthcare providers’ contamination and death: an international view [Crit Care, 2020-05-08]

Shortage of COVID-19 tests was reported by 42.5%.

... donor liver by 73.3%; more stringent restrictions were associated with higher regional incidence of COVID-19. Shortage of COVID-19 tests was reported by 42.5%. Respondents reported a total of 148 COVID-19 recipients from <1 to >10 years posttransplant: 69.6% ...

Ref: Early impact of COVID-19 on transplant center practices and policies in the United States [Am. j. transplant, 2020]

Undiagnosed COVID-19 results in inadequate isolation that can affect patient care and place healthcare workers at risk of contracting the virus.

... an algorithm requiring prior testing for viral respiratory and bacterial pathogens before testing for SARS-COV-2. Undiagnosed COVID-19 results in inadequate isolation that can affect patient care and place healthcare workers at risk of contracting the virus. In the current worldwide pandemic, physicians and healthcare workers should have a high index of ...

Ref: Case Report: The Importance of Novel Coronavirus Disease (COVID-19) and Coinfection with Other Respiratory Pathogens in the Current Pandemic [Am J Trop Med Hyg, 2020-04-17]

Lack of universal testing and death underreporting make between-country comparisons difficult. The country-level determinants of COVID-19 mortality are unknown.

Ref: Number of International Arrivals Predicts Severity of the first Global Wave of the COVID-19 Pandemic [Am J Trop Med Hyg, 2020-05-16]

Due to comorbidities, such as hypertension or diabetes, estimates of COVID-19 deaths have been questioned.

... reported if medical diagnostic criteria are met as judged by a physi-220 cian [20] . Due to comorbidities, such as hypertension or diabetes, estimates of COVID-19 deaths have been questioned. Arguments that death coinciding with a positive SARS-COV-2 test does not necessarily meet criteria for ...

Ref: Estimating the Global Infection Fatality Rate of COVID-19 [Am J Trop Med Hyg, 2020-05-18]

Testing rates over the past week have increased markedly, with a very low proportion of people testing positive.

... community. Cases of COVID-19 continue to be notified by jurisdictions, albeit at a slowed rate. Testing rates over the past week have increased markedly, with a very low proportion of people testing positive. These low rates of detection are indicative of low levels of COVID-19 transmission. It is ...

Ref: COVID-19, Australia: Epidemiology Report 15 (Reporting week to 23:59 AEST 10 May 2020) [Am J Trop Med Hyg, 2020]

Due to insufficient testing and treatment capacities at the beginning of the observation period, many infected people were not tested or hospitalized hence not on government statistics.

... [95% CI 0.86-0.99]. The evolution of a in Wuhan is in alignment with the reality. Due to insufficient testing and treatment capacities at the beginning of the observation period, many infected people were not tested or hospitalized hence not on government statistics. Through the addition of testing and treatment facilities, more infected people got tested and hospitalized, ...

Ref: Dynamic Estimation of Epidemiological Parameters of COVID-19 Outbreak and Effects of Interventions on Its Spread [Am J Trop Med Hyg, 2020-04-06]

Arguments that death coinciding with a positive SARS-COV-2 test does not necessarily meet criteria for a COVID-19 13 .

... Due to comorbidities, such as hypertension or diabetes, estimates of COVID-19 deaths have been questioned. Arguments that death coinciding with a positive SARS-COV-2 test does not necessarily meet criteria for a COVID-19 13 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has ...

Ref: Estimating the Global Infection Fatality Rate of COVID-19 [Am J Trop Med Hyg, 2020-05-18]

Children are strikingly absent from COVID-19 reports and limited data suggest that pediatric infections are overwhelmingly mild5.

... confirmed cases reported across all age groups, none of which were children under age 15. Children are strikingly absent from COVID-19 reports and limited data suggest that pediatric infections are overwhelmingly mild5. Thus, our estimates for hundreds of severe pediatric cases likely translates to thousands or even ...

Ref: Hundreds of severe pediatric COVID-19 infections in Wuhan prior to the lockdown [medRxiv, 2020-03-27]

Insufficient test capacity can cause delays and underestimates through multiple factors.

... picture of the state of a rapidly growing epidemic, early adequate testing capacity is essential. Insufficient test capacity can cause delays and underestimates through multiple factors. These include test backlogs, like reported delays of up to 10 days to get test ...

Ref: Severe underestimation of COVID-19 case numbers: effect of epidemic growth rate and test restrictions [medRxiv, 2020-04-17]

inconsistencies in reporting COVID-19 cases is a serious problem which might sabotage efforts to contain the virus.

... indicate that countries with lower HAQ-index may either underreport COVID-19 cases or are unable to adequately detect them. Although our data may be incomplete and must be interpreted with caution, inconsistencies in reporting COVID-19 cases is a serious problem which might sabotage efforts to contain the virus. ...

Ref: Internationally lost COVID-19 cases [J Microbiol Immunol Infect, 2020-03-14]

about 59,000 direct and indirect COVID-19 deaths might have been registered through the end of May but not yet publicly reported in full.

... Care"s count of 33,671 deaths, are appreciably less, implying that their counting methods have underestimated, not overestimated, the pandemic"s true death toll. If underreporting rates have held steady during May, about 59,000 direct and indirect COVID-19 deaths might have been registered through the end of May but not yet publicly reported in full. ...

Ref: Excess registered deaths in England and Wales during the COVID-19 pandemic, March 2020 to May 2020 [J Microbiol Immunol Infect, 2020-04-23]

Simply observing trends is not sufficient as spikes in deaths may occasionally occur.

... deaths in England and Wales that did not officially involve Covid-19 over the period 2015-2020. Simply observing trends is not sufficient as spikes in deaths may occasionally occur. I thus followed a difference-in-differences econometric approach to study whether there was a relative increase ...

Ref: Excess mortality during the Covid-19 pandemic: Early evidence from England and Wales [Soc Sci Med, 2020]

Infections were relatively less common in those aged under 20 years.

... men with confirmed COVID-19 infection was similar to the sex ratio in the general population. Infections were relatively less common in those aged under 20 years. The largest numbers of confirmed cases were detected in 3 of the 4 largest cities, ...

Ref: Epidemiological Analysis of the First 1389 Cases of COVID-19 in Poland: A Preliminary Report [Med Sci Monit, 2020]

A confirmed COVID-19 patients was defined as a case with respiratory specimens that tested positive for the SARS-CoV-2

... A confirmed COVID-19 patients was defined as a case with respiratory specimens that tested positive for the SARS-CoV-2 by at least one of the following three methods: isolation of SARS-CoV-2 or at least two positive results by real-time reverse-transcription-polymerase-chain-reaction (RT-PCR) assay for SARS-CoV-2 or a genetic sequence that ...

Ref: Transmission and epidemiological characteristics of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infected Pneumonia (COVID-19): preliminary evidence obtained in comparison with 2003-SARS [Med Sci Monit, 2020-02-02]

how many have developed severe disease and how many were tested positive but showed no clinical sign of disease?

... or a true lack of infection/susceptibility? Of the ones that have so far been tested, how many have developed severe disease and how many were tested positive but showed no clinical sign of disease? There are some basic questions that would provide a framework for which more specific and ...

Ref: The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak [J Autoimmun, 2020-02-26]

No significant association between COVID-19 incidence and absolute humidity was observed in distributed lag nonlinear models.

... 7 g/m3. COVID-19 incidence changed with temperature as daily incidence decreased when the temperature rose. No significant association between COVID-19 incidence and absolute humidity was observed in distributed lag nonlinear models. Additionally, A modified susceptible-exposed-infectious-recovered (M-SEIR) model confirmed that transmission rate decreased with the increase of ...

Ref: The impact of temperature and absolute humidity on the coronavirus disease 2019 (COVID-19) outbreak - evidence from China [J Autoimmun, 2020-03-24]

More than 25 labs in the state are now able to process COVID-19 testing.

... More than 25 labs in the state are now able to process COVID-19 testing. Total testing capacity statewide continues to change, which means each lab is the best source for current numbers on their own testing capacity. The results from all COVID-19 tests flow ...

Ref: COVID-19 Confirmed Case Incidence Age Shift to Young Persons Age 0-19 and 20-39 Years Over Time: Washington State March - April 2020 [J Autoimmun, 2020-05-23]

Counting only confirmed or probable COVID-19-associated deaths, however, likely underestimates the number of deaths attributable to the pandemic.

... of 13,831 laboratory-confirmed COVID-19-associated deaths, and 5,048 probable COVID-19-associated deaths were recorded in NYC (3). Counting only confirmed or probable COVID-19-associated deaths, however, likely underestimates the number of deaths attributable to the pandemic. The counting of confirmed and probable COVID-19-associated deaths might not include deaths among persons with ...

Ref: Preliminary Estimate of Excess Mortality During the COVID-19 Outbreak - New York City, March 11-May 2, 2020 [MMWR Morb Mortal Wkly Rep, 2020]

However, the reporting of test results, particularly for negative tests, has been inconsistent in many states.

... over time can help to indicate the potential for bias in estimates of reproductive numbers. However, the reporting of test results, particularly for negative tests, has been inconsistent in many states. In California, for example, there was a more than eight-fold increase in the number of ...

Ref: The impact of changes in diagnostic testing practices on estimates of COVID-19 transmission in the United States [medRxiv, 2020-04-24]

Reasons behind this might include Covid-19 underreporting, avoiding visits to hospitals or GPs, and the effects of the lockdown.

... has increased compared to what would have been expected in the absence of the pandemic. Reasons behind this might include Covid-19 underreporting, avoiding visits to hospitals or GPs, and the effects of the lockdown. I used weekly ONS data on the number of deaths in England and Wales that ...

Ref: Excess mortality during the Covid-19 pandemic: Early evidence from England and Wales [Soc Sci Med, 2020]

The prevalence of severe acute respiratory syndrome coronavirus 2 infection was determined by semiquantitative real-time reverse transcriptase–polymerase chain reaction on oropharyngeal samples.

... respiratory syndrome coronavirus 2. Data analysis was performed in March 2020. MAIN OUTCOMES AND MEASURES: The prevalence of severe acute respiratory syndrome coronavirus 2 infection was determined by semiquantitative real-time reverse transcriptase–polymerase chain reaction on oropharyngeal samples. Structured interviews were conducted to document symptoms for all HCWs with confirmed COVID-19. RESULTS: Of ...

Ref: Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic [JAMA Netw Open, 2020-05-21]

People exposed to the virus and showing symptoms must undergo polymerase chain reaction (PCR) test and, if positive, be isolated and treated.

... in order to help contain the disease and decrease the number of people being hospitalized. People exposed to the virus and showing symptoms must undergo polymerase chain reaction (PCR) test and, if positive, be isolated and treated. If the test turns out negative, it is advised to remain in home quarantine for ...

Ref: An Epidemiological Study on COVID-19: A Rapidly Spreading Disease [Cureus, 2020-03-18]

However, underreporting is likely to occur randomly and has not influenced our findings.

... we analyzed secondary data from surveillance systems, it is likely that COVID-19 deaths were underreported. Brazil is one of the countries performing the least number of tests for COVID-19 worldwide. However, underreporting is likely to occur randomly and has not influenced our findings. ...

Ref: Spatiotemporal evolution of coronavirus disease 2019 mortality in Brazil in 2020 [Revista da Sociedade Brasileira de Medicina Tropical, 2020-06-01]

This underscores the need for rapid testing, case detection and active contact tracing to isolate infectious individuals.

... perpetuity. (34) . Amplification of MERS in the hospital setting has been associated with diagnostic delays, which increase the window of opportunity for the generation of secondary cases (9) . This underscores the need for rapid testing, case detection and active contact tracing to isolate infectious individuals. ...

Ref: Transmission potential of COVID-19 in South Korea [Revista da Sociedade Brasileira de Medicina Tropical, 2020-02-29]

due to the shortage of diagnostic kits and inadequate screening of suspected cases (Imai et al., 2020) .

... et al., 2020) , underreporting likely occurred during the early stage of the COVID-19 outbreak, due to the shortage of diagnostic kits and inadequate screening of suspected cases (Imai et al., 2020) . A recent study by Tuite et al. (Tuite et al., 2020 ) estimated a total ...

Ref: Preliminary estimation of the novel coronavirus disease (COVID-19) cases in Iran: A modelling analysis based on overseas cases and air travel data [International Journal of Infectious Diseases, 2020-05-31]

we lacked data on transfers of critically ill patients from rural areas to facilities in large urban areas.

In the absence of sufficient tests, this study uses the death rates and the shares of cumulative positive tests in the lower-48 states

... of COVID-19 has been completely inadequate to determine the extent of infection in the population. In the absence of sufficient tests, this study uses the death rates and the shares of cumulative positive tests in the lower-48 states and the death rate in South Korea to estimate the size of the population infected ...

Ref: A Method to Identify the Missing COVID-19 Cases in the U.S. and Results for mid-April 2020 [J Am Coll Emerg Physicians Open, 2020-05-05]

At the same time, concerns have been voiced that COVID-19 testing has been insufficient and that many countries either lack testing kits and infrastructure,

... Amid the current COVID-19 pandemic, a continuous rise in mortality rates has been observed. At the same time, concerns have been voiced that COVID-19 testing has been insufficient and that many countries either lack testing kits and infrastructure, fear associated expenses or that cultural factors may impede virus" detection [1 -4] . Once patients ...

Ref: Evaluating the massive underreporting and undertesting of COVID-19 cases in multiple global epicenters [Pulmonology, 2020-06-06]

A higher share of individuals testing positive is almost certain to indicate that the COVID-19 cases more difficult to identify are missing.

... positive correlation between the death rates and the share of cumulative positive tests across states. A higher share of individuals testing positive is almost certain to indicate that the COVID-19 cases more difficult to identify are missing. The reported lag for test results from LabCorp and Quest Diagnostics on April 8 th ...

Ref: A Method to Identify the Missing COVID-19 Cases in the U.S. and Results for mid-April 2020 [Pulmonology, 2020-05-05]

Similar to reports from other countries, this finding suggests that the risk for serious disease and death from COVID-19 is higher in older age groups.

... adults aged ≥65 years with the highest percentage of severe outcomes among persons aged ≥85 years. In contrast, no ICU admissions or deaths were reported among persons aged ≤19 years. Similar to reports from other countries, this finding suggests that the risk for serious disease and death from COVID-19 is higher in older age groups. ...

Ref: Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020 [MMWR Morb Mortal Wkly Rep, 2020]

Almost all cases from the case series had positive computer tomography chest findings.

... to 14%, with the majority of the cases requiring admission to the intensive care unit. Almost all cases from the case series had positive computer tomography chest findings. All six and 22 cases that had nucleic-acid testing in vaginal mucus and breast milk ...

Ref: Effects of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcomes: a systematic review [Ultrasound obstet. gynecol, 2020]

First, COVID-19 daily new deaths in the USA are poorly understood, and are here described and studied using a semiparametric model.

... and result in different lag times. 19 This study provides several lines of valuable evidence. First, COVID-19 daily new deaths in the USA are poorly understood, and are here described and studied using a semiparametric model. Second, we extensively examined nine COVID-19-related search terms, which are more than the two used ...

Ref: Trends and Prediction in Daily New Cases and Deaths of COVID-19 in the United States: An Internet Search-Interest Based Model [Explor Res Hypothesis Med, 2020-04-18]

However, the data are subject to bias from reporting delays, with more recent counts excluding a proportion of deaths which have not yet been reported.

... deaths in hospitals in England NHS regions. All dates refer to the date of death. However, the data are subject to bias from reporting delays, with more recent counts excluding a proportion of deaths which have not yet been reported. To account for this, we excluded data from the last 3 weeks (i.e. from the ...

Ref: Analysis of temporal trends in potential COVID-19 cases reported through NHS Pathways England [Explor Res Hypothesis Med, 2020-05-20]

56.5% of programs had a resident waiting for, or unable to obtain, COVID-19 testing.

... residents presumed positive for COVID-19 based on symptoms but awaiting or unable to obtain testing. 56.5% of programs had a resident waiting for, or unable to obtain, COVID-19 testing. Two COVID-19-positive residents were hospitalized, with one in intensive care. Among specialties with >100 residents ...

Ref: Resident physician exposure to novel coronavirus (2019-nCoV, SARS-CoV-2) within New York City during exponential phase of COVID-19 pandemic: Report of the New York City Residency Program Directors COVID-19 Research Group [medRxiv : the preprint server for health sciences, 2020-04-28]

The meta-analysis and forest plots of two viral world infections showed that the incidence rate of COVID-19 infection is more than SARS infections,

... relations of incidence, mortality, and recovery rates of COVID-19 and SARS world infections were determined. The meta-analysis and forest plots of two viral world infections showed that the incidence rate of COVID-19 infection is more than SARS infections, while recovery and mortality event rates of SARS-CoV are more than COVID-19 infection. And subgroup ...

Ref: Comparative Global Epidemiological Investigation of SARS-CoV-2 and SARS-CoV Diseases Using Meta-MUMS Tool Through Incidence, Mortality, and Recovery Rates [Arch. med. res, 2020]

The high prevalence of mild clinical presentations, frequently not including fever,

... of acquisition of the virus in the community during the early phase of local spread. The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected COVID-19 should be used less stringently. ...

Ref: Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic [JAMA Netw Open, 2020-05-21]

No cases among staff members were identified after the initial round of testing.

... the others worked during or after symptom onset. Although serial RT-PCR testing of staff members was not feasible because of limited testing supplies, testing remained available for symptomatic staff members. No cases among staff members were identified after the initial round of testing. ...

Ref: Universal and Serial Laboratory Testing for SARS-CoV-2 at a Long-Term Care Skilled Nursing Facility for Veterans — Los Angeles, California, 2020 [MMWR Morb Mortal Wkly Rep, 2020-05-29]

the patients, who met the WHO criteria, may not be tested and subsequently not included in the daily incidence in the USA;

... cases and deaths Explor Res Hypothesis Med where the WHO criteria were adopted. 16-18 Thus, the patients, who met the WHO criteria, may not be tested and subsequently not included in the daily incidence in the USA; this could lead to underreporting of daily incidence. Third, the biological and socioeconomic differences between ...

Ref: Trends and Prediction in Daily New Cases and Deaths of COVID-19 in the United States: An Internet Search-Interest Based Model [Explor Res Hypothesis Med, 2020-04-18]

In patients who reported other symptoms, 51% reported either cough or fever and therefore met current guidelines for self-isolation.

... the cohort, 17% did not report any other symptom thought to be associated with COVID-19. In patients who reported other symptoms, 51% reported either cough or fever and therefore met current guidelines for self-isolation. CONCLUSIONS: Anosmia is reported in conjunction with well-reported symptoms of coronas virus, but 1 in ...

Ref: Presentation of new onset anosmia during the COVID-19 pandemic [Rhinology, 2020]

We checked correlation of all of the explanatory variables (see table 1, column 4) with case fatality rate using univariate linear regressions.

... fulfilling the two requirements, see fig. 1b ). For 32 out of them, number of performed tests was available. We checked correlation of all of the explanatory variables (see table 1, column 4) with case fatality rate using univariate linear regressions. Only outbreak duration demonstrated significant correlation with CFR (p = 0.028). ...

Ref: Untangling factors associated with country-specific COVID-19 incidence, mortality and case fatality rates during the first quarter of 2020 [Rhinology, 2020-04-27]

While reporting biases may confound our observations, our findings support exercising caution in determining potential correlation between BCG vaccination and COVID-19 incidence,

... preliminary, our analyses indicate that the BCG vaccination may not offer protection against CoV-2 infection. While reporting biases may confound our observations, our findings support exercising caution in determining potential correlation between BCG vaccination and COVID-19 incidence, in part due significantly lower rates of CoV-2 testing per million inhabitants in countries with ...

Ref: Exercising caution in correlating COVID-19 incidence and mortality rates with BCG vaccination policies due to variable rates of SARS CoV-2 testing [Rhinology, 2020-04-11]

Large discrepancies in percent positive tests suggest that specific states with higher rates of positive tests may require a greater degree of screening certainty before tests are performed.

... challenges beyond those experienced in urban areas. Given our analyses we advocate for expanded testing in rural areas. Currently, testing availability and screening criteria vary widely by state. 9, 17 Large discrepancies in percent positive tests suggest that specific states with higher rates of positive tests may require a greater degree of screening certainty before tests are performed. ...

Ref: A Commentary on Rural‐Urban Disparities in COVID‐19 Testing Rates per 100,000 and Risk Factors [J Rural Health, 2020-04-13]

Of these 92 women, 33 (36%) had positive COVID-19 test results.

... were evaluated and 92 had known or suspected COVID-19 (12.2%, 95% confidence interval [CI]: 10.0-14.7%). Of these 92 women, 33 (36%) had positive COVID-19 test results. Only one woman required hospital admission for 5 days due to COVID-19 (1.1%, 95% CI: ...

Ref: COVID-19 in Pregnant Women: Case Series from One Large New York City Obstetrical Practice. [American journal of perinatology, 2020-05-21]