The “official” number of SARS-CoV-2 cases and COVID-19 related deaths at the end of November 2022 has now exceeded 635 and 6.6 million, respectively. Owing to the bias generated by the unmeasured confounders (undertesting; underdiagnosis; and underreporting of positive cases) and their most likely causes (lack of economic, technical and/or human resources for testing; confusion of symptoms with other respiratory infectious diseases; motivations for averting mandatory isolation; self-testing; ample variation of clinical phenotypes and viral loads; unreliability of serological testing), we proffer that the reliability of these figures may be questionable, as would be all those others generated by public health agencies, institutes of health, safety networks and surveillance programs. The “underestimation window” not only varies widely according to the target setting (i.e., up to 99% in geographical areas where testing is mostly unavailable), but is also increasing exponentially. Before “official cases” will become the tip of the iceberg of all worldwide SARS-CoV-2 infections, we need to certify the technical failure of the current epidemiological system only based on laboratory diagnosis.

Uncontrolled confounding in COVID-19 epidemiology

Lippi, Giuseppe
;
Mattiuzzi, Camilla;
2023-01-01

Abstract

The “official” number of SARS-CoV-2 cases and COVID-19 related deaths at the end of November 2022 has now exceeded 635 and 6.6 million, respectively. Owing to the bias generated by the unmeasured confounders (undertesting; underdiagnosis; and underreporting of positive cases) and their most likely causes (lack of economic, technical and/or human resources for testing; confusion of symptoms with other respiratory infectious diseases; motivations for averting mandatory isolation; self-testing; ample variation of clinical phenotypes and viral loads; unreliability of serological testing), we proffer that the reliability of these figures may be questionable, as would be all those others generated by public health agencies, institutes of health, safety networks and surveillance programs. The “underestimation window” not only varies widely according to the target setting (i.e., up to 99% in geographical areas where testing is mostly unavailable), but is also increasing exponentially. Before “official cases” will become the tip of the iceberg of all worldwide SARS-CoV-2 infections, we need to certify the technical failure of the current epidemiological system only based on laboratory diagnosis.
2023
COVID-19, SARS-CoV-2, epidemiology
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/1080232
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