Estimated incidence of COVID-19 illness and hospitalization — United States, February–September, 2020

Reese, Heather; Iuliano, A Danielle; Patel, Neha N; Garg, Shikha; Kim, Lindsay; Silk, Benjamin J; Hall, Aron J; Fry, Alicia; Reed, Carrie

BACKGROUND: In the United States, laboratory confirmed coronavirus disease 2019 (COVID-19) is nationally notifiable. However, reported case counts are recognized to be less than the true number of cases because detection and reporting are incomplete and can vary by disease severity, geography, and over time. METHODS: To estimate the cumulative incidence SARS-CoV-2 infections, symptomatic illnesses, and hospitalizations, we adapted a simple probabilistic multiplier model. Laboratory-confirmed case counts that were reported nationally were adjusted for sources of under-detection based on testing practices in inpatient and outpatient settings and assay sensitivity. RESULTS: We estimated that through the end of September, 1 of every 2.5 (95% Uncertainty Interval (UI): 2.0–3.1) hospitalized infections and 1 of every 7.1 (95% UI: 5.8–9.0) non-hospitalized illnesses may have been nationally reported. Applying these multipliers to reported SARS-CoV-2 cases along with data on the prevalence of asymptomatic infection from published systematic reviews, we estimate that 2.4 million hospitalizations, 44.8 million symptomatic illnesses, and 52.9 million total infections may have occurred in the U.S. population from February 27–September 30, 2020. CONCLUSIONS: These preliminary estimates help demonstrate the societal and healthcare burdens of the COVID-19 pandemic and can help inform resource allocation and mitigation planning.