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Developing a National Strategy for SARS-CoV-2 Serosurveys in the United States

Developing a National Strategy for SARS-CoV-2 Serosurveys in the United States
Gigi Gronvall; Nancy Connell; Jason E. Farley; Tom Inglesby; Jacky M. Jennings; Shruti H. Mehta; Rachel West; Amanda Kobokovich
Date posted:
June 18, 2020
Publication type:
The Johns Hopkins Center for Health Security
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This document describes the value of serosurveys (antibody studies) for SARS-CoV-2 infections, the different methods by which they can be performed, and the resources required to produce actionable information. It provides recommendations for the US government and states for performing these studies and deriving value from them.

There are now millions of confirmed cases of COVID-19, caused by the SARS-CoV-2 virus, and in the United States, the death toll has passed 100,000. Estimating the prevalence of SARS-CoV-2 infection and recovery is important for decision makers and public health workers at national, state, and local levels. Using these numbers, sound decisions can be made about allocation of personal protective equipment (PPE), mitigation efforts, and, ultimately, vaccine procurement and prioritization. The immediate effectiveness of various public health interventions in limiting virus spread can be assessed and compared, and the true case fatality rate of SARS-CoV-2 infections can be determined. Long-term questions regarding medical sequelae that may require specific interventions can also be addressed.

Serosurveys for SARS-CoV-2 infections are performed using serology/antibody testing (or, equivalently, serological testing), which may be used to identify whether people were previously infected by SARS-CoV-2. It is important to identify these previous infections through serology, because current PCR and other rapid diagnostic tests can identify only the presence of viral material in people who are currently infected. Not everyone who is infected with SARS-CoV-2 will have the opportunity to be tested before the virus is cleared from their bodies, and current Centers for Disease Control and Prevention (CDC) estimates predict that 35% of US infections are asymptomatic.1 Furthermore, there are still many scientific unknowns about what a positive antibody test means, beyond having a history of infection. There are limited data on reinfections with SARS-CoV-2 after recovery from an initial infection, and emerging studies may be complicated by prolonged viral shedding.2,3 While immunity is generally assumed after infection, and reinfections have not been confirmed, it is unclear how long immunity will last or what level or type of antibodies correlate with immunity.

Suggested citation: Gronvall G, Connell N, Farley JE, et al. Developing a National Strategy for SARS-CoV-2 Serosurveys in the United States. Baltimore, MD: Johns Hopkins Center for Health Security; 2020.



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