Estimation of the fraction of COVID-19 infected people in U.S. states and countries worldwide

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, daily counts of confirmed cases and deaths have been publicly reported in real-time to control the virus spread. However, substantial undocumented infections have obscured the true size of the currently infected population, which is arguably the most critical number for public health policy decisions. We developed a machine learning framework to estimate time courses of actual new COVID-19 cases and current infections in all 50 U.S. states and the 50 most infected countries from reported test results and deaths. Using published epidemiological parameters, our algorithm optimized slowly varying daily ascertainment rates and a time course of currently infected cases each day. Severe under-ascertainment of COVID-19 cases was found to be universal across U.S. states and countries worldwide. In 25 out of the 50 countries, actual cumulative cases were estimated to be 5–20 times greater than the confirmed cases. Our estimates of cumulative incidence were in line with the existing seroprevalence rates in 46 U.S. states. Our framework projected for countries like Belgium, Brazil, and the U.S. that ~10% of the population has been infected once. In the U.S. states like Louisiana, Georgia, and Florida, more than 4% of the population was estimated to be currently infected, as of September 3, 2020, while in New York this fraction is 0.12%. The estimation of the actual fraction of currently infected people is crucial for any definition of public health policies, which up to this point may have been misguided by the reliance on confirmed cases.