Evaluating undercounts in epidemics: response to Maruotti et al. 2022

TL;DR

This paper critiques a mark-recapture method for estimating true infection counts in epidemics, demonstrating through simulations that it provides unreliable bounds and should not be used for undercount estimation.

Contribution

It provides a critical analysis showing the fundamental flaws of the mark-recapture approach in epidemic undercount estimation and advises against its use.

Findings

Simulations show the method estimates bounds independently of true ratios.

The approach consistently underestimates true undercounting.

The method is fundamentally flawed for epidemic undercount estimation.

Abstract

Maruotti et al. 2022 used a mark-recapture approach to estimate bounds on the true number of monkeypox infections in various countries. These approaches are fundamentally flawed; it is impossible to estimate undercounting based solely on a single stream of reported cases. Simulations based on a Richards curve for cumulative incidence show that, for reasonable epidemic parameters, the proposed methods estimate bounds on the ascertainment ratio of $\approx 0.2-0.5$ roughly independently of the true ascertainment ratio. These methods should not be used.