ArticleProceedings of the National Academy of Sciences of the United States of America2020
Estimating unobserved SARS-CoV-2 infections in the United States.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers, 1 of them a synthesis that pooled it.
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Who cites it
56 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Computational models predicting the early development of the COVID-19 pandemic in Sweden: systematic review, data synthesis, and secondary validation of accuracy.Scientific reports · 2022Pooled it
- Reconstructing the early spatial spread of pandemic respiratory viruses in the United States.Proceedings of the National Academy of Sciences of the United States of America · 2026Article
- How Will AI Shape the Future of Pandemic Response? Early Clues From Data Analytics.Risk analysis : an official publication of the Society for Risk Analysis · 2025Review
- Reconstructing the early spatial spread of pandemic respiratory viruses in the United States.medRxiv : the preprint server for health sciences · 2025Article
- Variability in the Population Diffusion Patterns of SARS-CoV-2 by Exposure Setting and Its Roles in Driving Epidemic Dynamics.Influenza and other respiratory viruses · 2025Article
- Estimating population infection rates from non-random testing data: Evidence from the COVID-19 pandemic.PloS one · 2024Article
- How enlightened self-interest guided global vaccine sharing benefits all: A modeling study.Journal of global health · 2023Article
- Ensemble inference of unobserved infections in networks using partial observations.PLoS computational biology · 2023Article
- Assessment of the impact of reopening strategies on the spatial transmission risk of COVID-19 based on a data-driven transmission model.Scientific reports · 2023Article
- Effectiveness of feedback control and the trade-off between death by COVID-19 and costs of countermeasures.Health care management science · 2023Article
- Estimating the undetected emergence of COVID-19 in the US.PloS one · 2023Article
- An expert judgment model to predict early stages of the COVID-19 pandemic in the United States.PLoS computational biology · 2022Article
- Optimal health and economic impact of non-pharmaceutical intervention measures prior and post vaccination in England: a mathematical modelling study.Royal Society open science · 2022Article
- Characterizing superspreading potential of infectious disease: Decomposition of individual transmissibility.PLoS computational biology · 2022Article
- Quarantine and testing strategies to ameliorate transmission due to travel during the COVID-19 pandemic: a modelling study.The Lancet regional health. Europe · 2022Article
- Comparative study of a mathematical epidemic model, statistical modeling, and deep learning for COVID-19 forecasting and management.Socio-economic planning sciences · 2022Article
- Towards an Accurate Estimation of COVID-19 Cases in Kazakhstan: Back-Casting and Capture-Recapture Approaches.Medicina (Kaunas, Lithuania) · 2022Article
- Genomic surveillance of SARS-CoV-2 in Puerto Rico reveals emergence of an autochthonous lineage and early detection of variants.Research square · 2022Article
- Inferring SARS-CoV-2 RNA shedding into wastewater relative to the time of infection.Epidemiology and infection · 2022Article
- Unrecognized introductions of SARS-CoV-2 into the US state of Georgia shaped the early epidemic.Virus evolution · 2022Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
By March 2020, COVID-19 led to thousands of deaths and disrupted economic activity worldwide. As a result of narrow case definitions and limited capacity for testing, the number of unobserved severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections during its initial invasion of the United States remains unknown. We developed an approach for estimating the number of unobserved infections based on data that are commonly available shortly after the emergence of a new infectious disease. The logic of our approach is, in essence, that there are bounds on the amount of exponential growth of new infections that can occur during the first few weeks after imported cases start appearing. Applying that logic to data on imported cases and local deaths in the United States through 12 March, we estimated that 108,689 (95% posterior predictive interval [95% PPI]: 1,023 to 14,182,310) infections occurred in the United States by this date. By comparing the model's predictions of symptomatic infections with local cases reported over time, we obtained daily estimates of the proportion of symptomatic infections detected by surveillance. This revealed that detection of symptomatic infections decreased throughout February as exponential growth of infections outpaced increases in testing. Between 24 February and 12 March, we estimated an increase in detection of symptomatic infections, which was strongly correlated (median: 0.98; 95% PPI: 0.66 to 0.98) with increases in testing. These results suggest that testing was a major limiting factor in assessing the extent of SARS-CoV-2 transmission during its initial invasion of the United States.
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