Since day one of the coronavirus pandemic, the U.S.
has not had enough tests. Faced with this shortage, medical professionals used what tests they had on people with the worst symptoms or whose occupations put them at high risk for infection. People who were less sick or asymptomatic did not get tested. Because of this, many infected people in the U.S. have not been tested, and much of the information public health officials have about the spread and deadliness of the virus does not provide a complete picture.
Short of testing every person in the U.S., the best way to get accurate data on who and how many people have been infected with the coronavirus is
I am a
professor of health policy and management at Indiana University, and random testing is exactly what we did in my state. From April 25 to May 1, our team randomly selected and tested thousands of Indiana residents, no matter if they'd been sick or not. From this testing we were able to get some of the first truly representative data on coronavirus infection rates at a state level.
We found that
2.8% of the state's population had been infected with SARS–CoV–2. We also found that minority communities – especially Hispanic communities – have been hit much harder by the virus. With this representative data, we were also able to calculate out just how deadly the virus really is.
The process of random testing
The goal of our study was to learn how many Indiana residents, in total, were currently or had been previously been infected by the coronavirus. To do this, the people our team tested needed to be an accurate representation of Indiana's population as a whole and we needed to use two tests on every person.
With the help of the Indiana State Department of Health, numerous state agencies and community leaders,
we set up 70 testing stations in cities and towns across Indiana. We then randomly selected people from a list created using state tax records and invited them to get tested, free of charge. Some groups showed up more readily than others and we adjusted the numbers to represent the demographics of the state accordingly.
Once a person showed up to our mobile testing sites, they were given both
a PCR swab test that looks for current infections and an antibody blood test that looks for evidence of past infection.
By testing randomly and looking for both current and past infections, we could extrapolate our results to the entire state of Indiana and get information about real infection rates of this virus.
The research team also worked with civic leaders from vulnerable communities to conduct open, nonrandom testing as well to see how the results of these two testing approaches would differ.
How widespread and how deadly
We tested more than 4,600 Indiana residents as part of the first wave of testing in the study. This included more than 3,600 randomly selected people and more than 900 volunteers who participated in open testing.
During the last week in April, we estimate that 1.7% of the population had active viral infections. An additional 1.1% had antibodies, showing evidence of previous infection. In total, we estimate that
2.8% of the population currently were or had previously been infected with the coronavirus with 95% confidence that the actual infection rate is between 2% and 3.7%.
Because our random sample was designed to be representative of the population of the state, we can assume with almost certainty that the entire state numbers are the same. That would mean that approximately 188,000 Indiana residents had been infected by late April. At that point, the official confirmed cases – not including deaths –
Focusing the tests on severe or high-risk people underestimated the true infection rate by a factor of 11.
Having a reliable estimate of the true number of people who have been infected also allowed us to calculate the infection fatality rate – the percentage of people infected with SARS-CoV-2 who die. In Indiana, we calculated the rate is 0.58%. For this calculation, we divided the number of COVID-19 deaths in Indiana – 1,099 at the time – into the total number of people that were determined to have been cumulatively infected at 2.8% of the population – 188,000.
Early estimates suggested that
5% to 6% of cases in the U.S. were fatal, which is similar to the 6.3% that you would get by dividing confirmed cases in Indiana – 17,000 – by the deaths – 1,099. The infection–fatality rate of 0.58% is thankfully far lower, but is nearly six times higher than the seasonal flu which has a death rate of 0.1%.
This random testing also allowed us to make accurate estimates about what percent of infected people are asymptomatic. In our study, about 44% of those who tested positive for active viral infection reported no symptoms. While this was already
suspected by experts, our estimate is likely the most accurate to date.
Race, job and living situation matter
The general trends and information about the virus are incredibly important, but just as important are the ways in which human actions influenced what people are most affected.
We asked every person we tested about their race, ethnicity and whether they lived with someone who was previously diagnosed with COVID-19.
Our analysis of the random sample suggests that COVID-19 rates are much higher in minority communities, especially in Hispanic communities, where approximately 8% were currently or previously infected. While we do not definitively know why, it is possible that members of the Hispanic community in Indiana are
more likely to be essential workers, live in extended family structures that include relatives beyond the nuclear family or both.
We further found that people who lived with a person who was COVID-19 positive were approximately 12 times more likely to have the virus themselves than people living in a home with no infections. Living with extended family and being more exposed due to one's job may make it easier for the virus to spread within some communities.
These findings, along with the relatively low 2.8% prevalence, suggest that social distancing slowed the spread of the virus in the larger population. However, the hardest-hit communities were those who, on average, are not able to practice social distancing as consistently as others.
What next?
Now that we have this information and have established a baseline, we will continue periodically testing a random sample of people in the state. Doing so will tell us how far the virus has infiltrated our population so that policy decisions can be tailored to the situation.
This is the first statewide random sample study in the U.S. and the numbers offer both points of hope and concern.
The good news is that social distancing worked. Efforts to slow the virus contained it to only 2.8% of the population and by slowing the spread of the virus in the community, Indiana bought some time to determine the best way forward. This provides more time for researchers to both determine the degree to which infection results in immunity and to accelerate the development of a vaccine.
But there is bad news as well. If only 2.8% of the population have been infected with SARS-CoV-2, 97.2% of the population have not been infected and could still get the virus. The risk for a large outbreak that could dwarf the initial wave is still very real.
The demographic distribution of infections, while disturbing, offers important information that can help public health officials direct testing, education and contact tracing resources that are language and culturally sensitive. The research team and the state health department are working with leaders from these communities to figure out how to best contain the spread of the virus in the areas most affected.
As businesses slowly reopen, we need to be vigilant with any and all safety precautions so that we do not lose the ground we gained by hunkering down. Hopefully numbers will go down, but regardless of what happens in the future, we now better know the foe we fight.
Nir Menachemi is a Professor of Health Policy and Management at IUPUI.
This article first appeared on The Conversation. You can find it here.
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Why do some folks use social media but don't engage?
Psychologist says people who never comment on social media share these 5 positive traits
For over 20 years, social media has developed into a staple in many people’s day-to-day lives. Whether it’s to keep in communication with friends and family, following the thoughts of celebrities, or watching cat videos while sipping your morning coffee, there seem to be two types of social media users: commenters and lurkers.
The term “lurker” sounds equally mysterious and insidious, with some social media users writing them off as non-participants at best or voyeurs at worst. However, mindfulness expert Lachlan Brown believes these non-commenters have some very psychologically positive and healthy traits. Let’s take a look at how each one of these traits could be beneficial and see how fruitful lurking might be even though it can drive content creators crazy.
1. Cautious about vulnerability
Consciously or not, making a post online or commenting on one puts you and your words out there. It’s a statement that everyone can see, even if it’s as simple as clicking “like.” Doing so opens yourself up to judgment, with all the good, bad, and potential misinterpretation that comes with it. Non-commenters would rather not open themselves up to that.
These silent users are connected to a concept of self-protection by simply not engaging. By just scrolling past posts or just reading/watching them without commentary, they’re preventing themselves from any downsides of sharing an opinion such as rejection, misunderstanding, or embarrassment. They also have more control on how much of themselves they’re willing to reveal to the general public, and tend to be more open face-to-face or during one-on-one/one-on-few private chats or DMs. This can be seen as a healthy boundary and prevents unnecessary exposure.
Considering many comment sections, especially involving political topics, are meant to stir negative emotional responses to increase engagement, being extra mindful about where, when, and what you comment might not be a bad idea. They might not even take the engagement bait at all. Or if they see a friend of theirs post something vulnerable, they feel more motivated to engage with them personally one-on-one rather than use social media to publicly check in on them.
2. Analytical and reflective mindset
How many times have you gone onto Reddit, YouTube, or any other site and just skimmed past comments that are just different versions of “yes, and,” “no, but,” or “yes, but”? Or the ever insightful, formerly popular comment “First!” in a thread? These silent browsers lean against adding to such noise unless they have some valid and thoughtful contribution (if they bother to comment period).
These non-posters are likely wired on reflective thinking rather than their initial intuition. Not to say that all those who comment aren’t thoughtful, but many tend to react quickly and comment based on their initial feelings rather than absorbing the information, thinking it over, researching or testing their belief, and then posting it. For "lurkers," it could by their very nature to just do all of that and not post it at all, or share their thoughts and findings privately with a friend. All in all, it’s a preference of substance over speed.
3. High sense of self-awareness
Carried over from the first two listed traits, these silent social media users incorporate their concern over their vulnerability and their reflective mindset into digital self-awareness. They know what triggers responses out of them and what causes them to engage in impulsive behavior. It could be that they have engaged with a troll in the past and felt foolish. Or that they just felt sad after a post or got into an unnecessary argument that impacted them offline. By knowing themselves and seeing what’s being discussed, they choose to weigh their words carefully or just not participate at all. It’s a form of self-preservation through restraint.
4. Prefer to observe rather than perform
Some folks treat social media as information, entertainment, or a mix of both, and commenting can feel like they’re yelling at the TV, clapping alone in a movie theater when the credits roll, or yelling “That’s not true!” to a news anchor that will never hear them. But contrary to that, social media is a place where those yells, claps, and accusations can be seen and get a response. By its design, social media is considered by experts and the media as performative, regardless of whether it is positive or negative. Taking all of the previously mentioned traits into account, one can see why they would prefer to “observe the play” rather than get up on the stage of Facebook or X.
On top of that, these non-commenters could be using social media differently than those who choose to fully engage with it. Using this type of navigation, there may be nothing for them to comment about. Some commenters are even vying for this for their mental health. There are articles about how to better curate your social media feeds and manipulate algorithms to create a better social media experience to avoid unnecessary conflict or mentally tiring debate.
If you go on a blocking spree on all of your accounts and just follow the posters that boost you, it could turn your social media into a nice part of your routine as you mainly engage with others face-to-face or privately. In terms of commenting, if your curated Instagram is just following cute dogs and all you have to offer for a comment is “cute dog,” you might just enjoy the picture and then move on with your day rather than join in the noise. These non-commenters aren’t in the show and they’re fine with it.
5. Less motivated by social validation
The last trait that Brown showcases is that social media users who browse without posting tend to be independent from external validation, at least online. Social media is built to grow through feedback loops such as awarding likes, shares, and reposts of your content along with notifications letting you know that a new person follows you or wants to connect. This can lead many people to connect their activity on social media with their sense of self worth, especially with adolescents who are still figuring out their place in the world and have still-developing brains.
Engaging in social media via likes, shares, comments, and posts rewards our brains by having them release dopamine, which makes us feel good and can easily become addictive. For whatever reason, non-commenters don’t rely on social media as a means to gauge their social capital or self worth. This doesn’t make them better than those who do. While some non-commenters could have healthier ways to boost their self worth or release dopamine into their systems, many get that validation from equally unhealthy sources offline. That said, many non-commenters’ silence could be a display of independence and self confidence.
Whether you frequently comment online or don’t, it’s good to understand why you do or don’t. Analyzing your habits can help you determine whether your online engagement is healthy, or needs to be tweaked. With that information, you can then create a healthy social media experience that works for you.