Incorporating false negative tests in epidemiological models for SARS-CoV-2 transmission and reconciling with seroprevalence estimates

Sci Rep. 2021 May 7;11(1):9748. doi: 10.1038/s41598-021-89127-1.

Abstract

Susceptible-Exposed-Infected-Removed (SEIR)-type epidemiologic models, modeling unascertained infections latently, can predict unreported cases and deaths assuming perfect testing. We apply a method we developed to account for the high false negative rates of diagnostic RT-PCR tests for detecting an active SARS-CoV-2 infection in a classic SEIR model. The number of unascertained cases and false negatives being unobservable in a real study, population-based serosurveys can help validate model projections. Applying our method to training data from Delhi, India, during March 15-June 30, 2020, we estimate the underreporting factor for cases at 34-53 (deaths: 8-13) on July 10, 2020, largely consistent with the findings of the first round of serosurveys for Delhi (done during June 27-July 10, 2020) with an estimated 22.86% IgG antibody prevalence, yielding estimated underreporting factors of 30-42 for cases. Together, these imply approximately 96-98% cases in Delhi remained unreported (July 10, 2020). Updated calculations using training data during March 15-December 31, 2020 yield estimated underreporting factor for cases at 13-22 (deaths: 3-7) on January 23, 2021, which are again consistent with the latest (fifth) round of serosurveys for Delhi (done during January 15-23, 2021) with an estimated 56.13% IgG antibody prevalence, yielding an estimated range for the underreporting factor for cases at 17-21. Together, these updated estimates imply approximately 92-96% cases in Delhi remained unreported (January 23, 2021). Such model-based estimates, updated with latest data, provide a viable alternative to repeated resource-intensive serosurveys for tracking unreported cases and deaths and gauging the true extent of the pandemic.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Antibodies, Viral / immunology
  • COVID-19 / diagnosis*
  • COVID-19 / epidemiology*
  • COVID-19 / immunology
  • COVID-19 / transmission
  • COVID-19 Testing
  • Child
  • Child, Preschool
  • False Negative Reactions
  • Female
  • Humans
  • Immunoglobulin G / immunology
  • India / epidemiology
  • Male
  • SARS-CoV-2 / immunology
  • SARS-CoV-2 / isolation & purification*
  • Seroepidemiologic Studies
  • Young Adult

Substances

  • Antibodies, Viral
  • Immunoglobulin G