Resurgence of SARS-CoV-2: Detection by community viral surveillance

Riley, Steven; Ainslie, Kylie E. C.; Eales, Oliver; Walters, Caroline E.; Wang, Haowei; Atchison, Christina; Fronterre, Claudio; Diggle, Peter J.; Ashby, Deborah; Donnelly, Christl A.; Cooke, Graham; Barclay, Wendy; Ward, Helen; Darzi, Ara; Elliott, Paul

Surveillance of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has mainly relied on case reporting, which is biased by health service performance, test availability, and test-seeking behaviors. We report a community-wide national representative surveillance program in England based on self-administered swab results from ~594,000 individuals tested for SARS-CoV-2, regardless of symptoms, between May and the beginning of September 2020. The epidemic declined between May and July 2020 but then increased gradually from mid-August, accelerating into early September 2020 at the start of the second wave. When compared with cases detected through routine surveillance, we report here a longer period of decline and a younger age distribution. Representative community sampling for SARS-CoV-2 can substantially improve situational awareness and feed into the public health response even at low prevalence.