Antibody Testing Documents the Silent Spread of SARS-CoV-2in New York Prior to the First Reported Case

Abstract

<jats:title>Abstract</jats:title> <jats:p>We developed and validated serologic assays to determine SARS-CoV-2 seroprevalence in select patient populations in greater New York City area early during the epidemic. We tested “discarded” serum samples from February 24 to March 29 for antibodies against SARS-CoV-2 spike trimer and nucleocapsid protein. Using known durations for antibody development, incubation period, serial interval, and reproductive ratio for this pandemic, we determined that introduction of SARS-CoV-2 into New York likely occurred between January 23 and February 4, 2020. SARS-CoV-2 spread silently for 4–5 weeks before the first community acquired infection was reported. A novel coronavirus emerged in December 2019 in Wuhan, China<jats:sup>1,2</jats:sup> and devasted Hubei Province in early 2020 before spreading to every province within China and nearly every country in the world<jats:sup>3</jats:sup>. This pathogen, now termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a global pandemic, with ~ 10 million cases and over 500,000 deaths reported through June 30, 2020<jats:sup>3</jats:sup>. The first case of SARS-CoV-2 infection in the United States was identified on January 19, 2020 in a man who returned to the State of Washington from Wuhan<jats:sup>4</jats:sup>. In the ensuing months, the U.S. has become a hotspot of the pandemic, presently accounting for almost one third of the total caseload and over one fourth of the deaths<jats:sup>3</jats:sup>. The first confirmed case in New York was reported on March 1 in a traveler recently returned from Iran. The first community-acquired SARS-CoV-2 infection was diagnosed on March 3 in a 50-year-old male who lived in New Rochelle and worked in New York City (https://www1.nyc.gov/site/doh/covid/covid-19-data-archive.page.) In the ensuing 18 weeks, New York City has suffered a peak daily infection number of ~ 4,500 (Fig. 1a) and a cumulative caseload of ~ 400,000 to date. The time period when SARS-CoV-2 gained entry into this epicenter of the pandemic remains unclear.</jats:p>

Infection fatality rate of COVID-19 inferred from seroprevalence data

“…For other studies, healthy volunteer bias 19 may underestimate seroprevalence, attracting people with symptoms 26 may overestimate seroprevalence, and studies of employees, 14 , 21 , 25 , 32 , 66 grocery store clients 23 or patient cohorts 11 , 14 , 27 – 30 , 36 , 38 , 40 , 50 , 51 , 56 , 59 , 62 , 64 , 67 risk sampling bias in an unpredictable direction.…”

“…The very many deaths in nursing homes, nosocomial infections and overwhelmed hospitals may also explain the high number of fatalities in specific locations in Italy 84 and New York and neighbouring states. 23 , 27 , 35 , 56 Poor decisions (e.g. sending COVID-19 patients to nursing homes), poor management (e.g.…”