Estimates on COVID-19 Incidence Have Been Too Low—so Start Testing More Aggressively

It looks like millions of cases were missing from the number of U.S. COVID-19 infections reported through September 2020, according to data just published in JAMA Network Open. The problem seems to have been a lack of understanding of how prevalent the virus could be in asymptomatic patients. Blood samples from 61,910 adults who were “well” at the time they applied for life insurance showed a 6.6% positivity rate. Extrapolating that rate to the entire population adds 16 million cases, nearly doubling the number of cases presumed at the time. This retrospective view speaks to the importance of proactive testing among patients who have no complaints indicative of COVID-19, especially with workplace, school, and travel restrictions starting to be relaxed in many states (and to the necessity for ongoing vaccination efforts, of course).