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. 2023 Jun 30;3(1):92.
doi: 10.1038/s43856-023-00321-w.

The prevalence of SARS-CoV-2 infection and other public health outcomes during the BA.2/BA.2.12.1 surge, New York City, April-May 2022

Saba A Qasmieh  1   2 , McKaylee M Robertson  1   2 , Chloe A Teasdale  1   2 , Sarah G Kulkarni  1 , Heidi E Jones  1   2 , David A Larsen  3 , John J Dennehy  4 , Margaret McNairy  1   5 , Luisa N Borrell  2 , Denis Nash  6   7
Affiliations

The prevalence of SARS-CoV-2 infection and other public health outcomes during the BA.2/BA.2.12.1 surge, New York City, April-May 2022

Saba A Qasmieh et al. Commun Med (Lond). .

Abstract

Background: Routine case surveillance data for SARS-CoV-2 are incomplete, unrepresentative, missing key variables of interest, and may be increasingly unreliable for timely surge detection and understanding the true burden of infection.

Methods: We conducted a cross-sectional survey of a representative sample of 1030 New York City (NYC) adult residents ≥18 years on May 7-8, 2022. We estimated the prevalence of SARS-CoV-2 infection during the preceding 14-day period. Respondents were asked about SARS-CoV-2 testing, testing outcomes, COVID-like symptoms, and contact with SARS-CoV-2 cases. SARS-CoV-2 prevalence estimates were age- and sex-adjusted to the 2020 U.S.

Population: We triangulated survey-based prevalence estimates with contemporaneous official SARS-CoV-2 counts of cases, hospitalizations, and deaths, as well as SARS-CoV-2 wastewater concentrations.

Results: We show that 22.1% (95% CI 17.9-26.2%) of respondents had SARS-CoV-2 infection during the two-week study period, corresponding to ~1.5 million adults (95% CI 1.3-1.8 million). The official SARS-CoV-2 case count during the study period is 51,218. Prevalence is estimated at 36.6% (95% CI 28.3-45.8%) among individuals with co-morbidities, 13.7% (95% CI 10.4-17.9%) among those 65+ years, and 15.3% (95% CI 9.6-23.5%) among unvaccinated persons. Among individuals with a SARS-CoV-2 infection, hybrid immunity (history of both vaccination and infection) is 66.2% (95% CI 55.7-76.7%), 44.1% (95% CI 33.0-55.1%) were aware of the antiviral nirmatrelvir/ritonavir, and 15.1% (95% CI 7.1-23.1%) reported receiving it. Hospitalizations, deaths and SARS-CoV-2 virus concentrations in wastewater remained well below that during the BA.1 surge.

Conclusions: Our findings suggest that the true magnitude of NYC's BA.2/BA.2.12.1 surge may have been vastly underestimated by routine case counts and wastewater surveillance. Hybrid immunity, bolstered by the recent BA.1 surge, likely limited the severity of the BA.2/BA.2.12.1 surge.

Plain language summary

It is difficult to assess the true prevalence of SARS-CoV-2, the virus that causes COVID-19, due to changes in testing practices and behaviors, including increasing at-home testing and decreasing healthcare provider-based testing. We conducted a population-representative survey in New York City to estimate the prevalence of SARS-CoV-2 during the second Omicron surge in spring 2022. We compared survey-based SARS-CoV-2 prevalence estimates with data on diagnosed cases, hospitalizations, deaths, and SARS-CoV-2 concentration in wastewater. Our survey-based estimates were nearly 30 times higher than official case counts and estimates of immunity among those with active infection were high. Taken together, our results suggest that the magnitude of the second Omicron surge was likely significantly underestimated, and high levels of immunity likely prevented a major surge in hospitalizations/deaths. Our findings might inform future work on COVID-19 surveillance and how to mitigate its spread.

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Conflict of interest statement

D.N., M.R., and S.K. report support from a SARS-CoV-2 research grant from Pfizer to their institution. D.N. reports consulting fees from Abbvie and Gilead. The remaining authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Associations of household size and children in the household with SARS-CoV-2 prevalence.
Age- and sex-adjusted SARS-CoV-2 prevalence estimates and 95% confidence interval (95% CI) among NYC adults by household size and presence of children in the household, April–May, 2022.
Fig. 2
Fig. 2. Hybrid immunity among adults with and without SARS-CoV-2 infection, NYC April–May 2022.
Estimates were obtained by combining self-reported information on uptake of SARS-CoV-2 vaccination with history of prior SARS-CoV-2 infection.
Fig. 3
Fig. 3. Total PCR tests, antigen tests, positive PCR tests, positive antigen tests, COVID-19 related hospitalizations and deaths, NYC.
Variant eras for NYC were approximated based on the timing of peaks and troughs in COVID-related hospitalizations in NYC as follows: 1 December 2021–1 March 2022 (BA.1) and 1 March 2022–6 June 2022 (BA.2/BA.2.12.1).
Fig. 4
Fig. 4. Mean per capita SARS-CoV-2 concentrations from 14 water resource recovery facilities (WRRFs) in NYC.
WRRFs in NYC cover wastewater of an estimated 8.2 million residents. WRRFs are sampled up to twice each week and per capita SARS-CoV-2 load (N1 copies per capita) is reported for each sample date. We plotted the mean per capita SARS-CoV-2 load by sample date across all 14 WRRFs. Variant eras for NYC were approximated based on the timing of peaks and troughs in COVID-related hospitalizations in NYC as follows: 1 December 2021–1 March 2022 (BA.1) and 1 March 2022–6 June 2022 (BA.2).
See this image and copyright information in PMC

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