Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York

ABSTRACT

ImportanceNew York State (NYS) is an epicenter of the United States COVID-19 epidemic. Reliable estimates of cumulative incidence of SARS-CoV-2 infection in the population are critical to tracking the extent of transmission and informing policies, but US data are lacking, in part because societal closure complicates study conduct. ObjectiveTo estimate the cumulative incidence of SARS-CoV-2 infection and percent of infections diagnosed in New York State, overall and by region, age, sex, and race and ethnicity. DesignStatewide cross-sectional seroprevalence study, conducted April 19-28, 2020. SettingGrocery stores (n=99) located in 26 counties throughout NYS, which were essential businesses that remained open during a period of societal closure and attract a heterogenous clientele. ParticipantsConvenience sample of patrons [≥]18 years and residing in New York State, recruited consecutively upon entering stores and via an in-store flyer. ExposuresRegion (New York City, Westchester/Rockland, Long Island, Rest of New York State), age, sex, race and ethnicity. Main OutcomesPrimary outcome: cumulative incidence of SARS-CoV-2 infection, based on dry-blood spot (DBS) SARS-CoV-2 antibody reactivity; secondary outcome: percent of infections diagnosed. ResultsAmong 15,101 adults with suitable DBS specimens, 1,887 (12.5%) were reactive using a validated SARS-CoV-2 IgG microsphere immunoassay (sensitivity 87.9%, specificity 99.75%). Following post-stratification weighting on region, sex, age, and race and ethnicity and adjustment for assay characteristics, estimated cumulative incidence through March 29 was 14.0% (95% CI 13.3-14.7%), corresponding to 2,139,300 (95% CI 2,035,800-2,242,800) infection-experienced adults. Cumulative incidence was higher among Hispanic/Latino (29.2%, 95% CI 27.2-31.2%), non-Hispanic black/African American (20.2% 95% CI, 18.1-22.3%), and non-Hispanic Asian (12.4%, 95% CI 9.4-15.4%) adults than non-Hispanic white adults (8.1%, 95% CI 7.4-8.7%, p<.0001). Cumulative incidence was highest in New York City (NYC) 22.7% (95% CI 21.5%-24.0). Dividing diagnoses reported to NYS by estimated infection-experienced adults, an estimated 8.9% (95% CI 8.4-9.3%) of infections were diagnosed, with those [≥]55 years most likely to be diagnosed (11.3%, 95% CI 10.4-12.2%). Conclusions and RelevanceOver 2 million adults were infected through late March 2020, with substantial variations by subpopulations. As this remains below herd immunity thresholds, monitoring, testing, and contact tracing remain essential public health strategies.