ABSTRACT
BackgroundThough the use of home testing is increasing, it is not represented in the reported coronavirus disease 2019 (COVID-19) metrics. As the epidemic and its tracking evolve, it is critical to understand who the excluded home-tested persons are relative to those in reported metrics. MethodsFive New York State databases were linked to understand the trends in home-tested COVID-19 cases compared to laboratory-confirmed cases from November 2021 to April 2022. Frequency distributions, logistic regression adjusted odds ratios (aOR), and 95% confidence intervals (CI) were used to compare the characteristics of home-tested and laboratory-tested persons. ResultsOf 592,227 confirmed COVID-19 cases, 71,531 (12%) had a home-test-only, 515,001 (87%) had a laboratory-test-only and 5,695 (1%) had both a home-test and laboratory-test during this period. Home-tested cases, as a percentage of confirmed COVID-19 cases, increased from 1% in November 2021 to 22% in April 2022. Children aged 5-11 years with 3.74 aOR (95% CI:3.53, 3.96) and adolescents aged 12-17 years with 3.24 aOR (95% CI:3.07, 3.43) were more likely to have home-test-only than adults aged 65 and above. Boosted (aOR 1.87, 95% CI:1.82, 1.93), in K-12 school settings (aOR 2.33, 95% CI:2.27, 2.40), or possibly infected by a household member (aOR 1.17, 95% CI:1.13, 1.22) were more likely to report home-test-only than laboratory-test-only. Individuals hospitalized (aOR 0.04, 95% CI:0.03, 0.06), with underlying conditions (aOR 0.85, 95% CI:0.83, 0.87), pregnant (aOR 0.76, 95% CI:0.66, 0.86), Hispanic (aOR 0.50:95% CI:0.48, 0.53), Asian (aOR 0.31, 95% CI:0.28, 0.34), or Black (aOR 0.45, 95% CI:0.42, 047) were less likely to utilize the home test only compared to the laboratory test only. ConclusionThe number of individuals using home tests only as a proportion of confirmed COVID-19 cases continues to increase. Home test-only cases are less likely to be hospitalized and have a lower potential for severe disease as measured by age, vaccination status, and underlying conditions. Thus, those with severe disease and the potential for severe disease are represented as official metrics. Racial and ethnic differences exist between persons reporting home and laboratory tests.
ABSTRACT
BackgroundUS population-based data on COVID-19 vaccine effectiveness (VE) for the 3 currently FDA-authorized products is limited. Whether declines in VE are due to waning immunity, the Delta variant, or other causes, is debated. MethodsWe conducted a prospective study of 8,834,604 New York adults, comparing vaccine cohorts defined by product, age, and month of full-vaccination to age-specific unvaccinated cohorts, by linking statewide testing, hospital, and vaccine registry databases. VE was estimated from May 1, 2021 for incident laboratory-confirmed COVID-19 cases (weekly life-table hazard rates through September 3) and hospitalizations (monthly incidence rates through August 31). Results155,092 COVID-19 cases and 14,862 hospitalizations occurred. Estimated VE for cases declined contemporaneously across age, products, and time-cohorts, from high levels beginning May 1 (1.8% Delta variant prevalence), to a nadir around July 10 (85.3% Delta), with limited changes thereafter (>95% Delta). Decreases were greatest for Pfizer-BioNTech (-24.6%, -19.1%, -14.1% for 18-49, 50-64 years, and [≥]65 years, respectively), and similar for Moderna (-18.0%, -11.6%, -9.0%, respectively) and Janssen (-19.2%, -10.8, -10.9%, respectively). VE for hospitalization for adults 18-64 years was >86% across cohorts, without time trend. Among persons [≥]65 years, VE declined from May to August for Pfizer-BioNTech (95.0% to 89.2%) and Moderna (97.2% to 94.1%). VE was lower for Janssen, without trend, ranging 85.5%-82.8%. ConclusionsDeclines in VE for cases may have been primarily driven by factors other than waning. VE for hospitalizations remained high, with modest declines limited to Pfizer-BioNTech and Moderna recipients [≥]65 years, supporting targeted booster dosing recommendations.