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Emerg Infect Dis . Predictors of Test Positivity, Mortality, and Seropositivity during the Early Coronavirus Disease Epidemic, Orange County, California, USA

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  • Emerg Infect Dis . Predictors of Test Positivity, Mortality, and Seropositivity during the Early Coronavirus Disease Epidemic, Orange County, California, USA


    Emerg Infect Dis


    . 2021 Oct;27(10):2604-2618.
    doi: 10.3201/eid2710.210103.
    Predictors of Test Positivity, Mortality, and Seropositivity during the Early Coronavirus Disease Epidemic, Orange County, California, USA

    Daniel M Parker, Tim Bruckner, VerĂ³nica M Vieira, Catalina Medina, Vladimir N Minin, Philip L Felgner, Alissa Dratch, Matthew Zahn, Scott M Bartell, Bernadette Boden-Albala

    Abstract

    We conducted a detailed analysis of coronavirus disease in a large population center in southern California, USA (Orange County, population 3.2 million), to determine heterogeneity in risks for infection, test positivity, and death. We used a combination of datasets, including a population-representative seroprevalence survey, to assess the actual burden of disease and testing intensity, test positivity, and mortality. In the first month of the local epidemic (March 2020), case incidence clustered in high-income areas. This pattern quickly shifted, and cases next clustered in much higher rates in the north-central area of the county, which has a lower socioeconomic status. Beginning in April 2020, a concentration of reported cases, test positivity, testing intensity, and seropositivity in a north-central area persisted. At the individual level, several factors (e.g., age, race or ethnicity, and ZIP codes with low educational attainment) strongly affected risk for seropositivity and death.

    Keywords: COVID-19; California; Orange County; SARS-CoV-2; United States; coronavirus disease; health equity; mortality; respiratory infections; seropositivity; severe acute respiratory syndrome coronavirus 2; test positivity; viruses; zoonoses.

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