Unveiling hidden cases: Hospital screening as a proxy for SARS-CoV-2 incidence in the general population

During the COVID-19 pandemic, SARS-CoV-2 incidence served as a critical metric for monitoring the epidemiological situation and guiding public health policies. However, as testing requirements and strategies evolved throughout the pandemic, an increasing number of SARS-CoV-2 infections may have remained undetected. This study investigates alternative indicators for estimating unreported SARS-CoV-2 infections.

This study uses a retrospective observational approach, analysing SARS-CoV-2 incidence data from different population groups to determine correlations and identify potential proxy indicators for incidence in the general population.

Monthly SARS-CoV-2 incidence rates from January 03, 2020 to April 30, 2023 in the general Bavarian population were compared with incidence rates among three reference populations at a Bavarian tertiary care hospital: healthcare workers (HCWs), inpatients, and visitors. Correlations and cross-correlations were calculated to assess the potential of these datasets as proxies for estimating general population incidence.

The general population reported incidence was highly correlated with the HCWs (r = 0.84) and the inpatient incidence (r = 0.81), while visitor incidence exhibited a weaker correlation (r = 0.35). Restricting analysis to data up to March 2022 - used as a reference point after which the general population reported incidence consistently fell below the indicator-based incidences - the correlations increased for HCWs (r = 0.92) and inpatients (r = 0.92).

The 2022 reversal of incidence data indicates an underreporting of SARS-CoV-2 infections. Screening data from tertiary care hospitals are an important public health strategy for estimating current incidence rates, especially in the post-pandemic period, even when case monitoring is stopped or decompensated. Incidence rates among HCWs and inpatients in low-threshold testing environments are reliable proxies for general population reported incidence, offering valuable insights into SARS-CoV-2 and other acute respiratory viruses in the post-pandemic era.