Routine Hospital-based SARS-CoV-2 Testing Outperforms State-based Data in Predicting Clinical Burden

TL;DR

This study introduces a hospital-based SARS-CoV-2 testing method using multilevel regression and poststratification to better estimate community viral incidence and predict clinical burden more accurately than traditional community testing data.

Contribution

The paper presents a novel hospital-based sampling approach with statistical adjustment that improves prediction of COVID-19 clinical burden over existing community data methods.

Findings

Hospital-based testing predicts clinical burden earlier.

The method provides more accurate community viral incidence estimates.

Applicable across diverse hospital settings.

Abstract

Throughout the COVID-19 pandemic, government policy and healthcare implementation responses have been guided by reported positivity rates and counts of positive cases in the community. The selection bias of these data calls into question their validity as measures of the actual viral incidence in the community and as predictors of clinical burden. In the absence of any successful public or academic campaign for comprehensive or random testing, we have developed a proxy method for synthetic random sampling, based on viral RNA testing of patients who present for elective procedures within a hospital system. We present here an approach under multilevel regression and poststratification (MRP) to collecting and analyzing data on viral exposure among patients in a hospital system and performing statistical adjustment that has been made publicly available to estimate true viral incidence and trends in the community. We apply our MRP method to track viral behavior in a mixed urban-suburban-rural setting in Indiana. This method can be easily implemented in a wide variety of hospital settings. Finally, we provide evidence that this model predicts the clinical burden of SARS-CoV-2 earlier and more accurately than currently accepted metrics.