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After adjusting for population and test performance characteristics, we estimate that the seroprevalence of
antibodies to SARS-CoV-2 in Santa Clara County is between 2.49% and 4.16%, with uncertainty bounds
ranging from 1.80% (lower uncertainty bound of the lowest estimate), up to 5.70% (upper uncertainty
bound of the highest estimate).
The most important implication of these findings is that the number of infections is much greater than the
reported number of cases. Our data imply that, by April 1 (three days prior to the end of our survey)
between 48,000 and 81,000 people had been infected in Santa Clara County. The reported number of
confirmed positive cases in the county on April 1 was 956, 50-85-fold lower than the number of
infections predicted by this study.17 The infection to case ratio, also referred to as an under-ascertainment
rate, of at least 50, is meaningfully higher than current estimates.10,18 This ascertainment rate is a
fundamental parameter of many projection and epidemiologic models, and is used as a calibration target
for understanding epidemic stage and calculating fatality rates.19,20 The under-ascertainment for COVID-
19 is likely a function of reliance on PCR for case identification which misses convalescent cases, early
spread in the absence of systematic testing, and asymptomatic or lightly symptomatic infections that go
undetected.
We can use our prevalence estimates to approximate the infection fatality rate from COVID-19 in Santa
Clara County. As of April 10, 2020, 50 people have died of COVID-19 in the County, with an average
increase of 6% daily in the number of deaths. If our estimates of 48,000-81,000 infections represent the
cumulative total on April 1, and we project deaths to April 22 (a 3 week lag from time of infection to
death22), we estimate about 100 deaths in the county. A hundred deaths out of 48,000-81,000 infections
corresponds to an infection fatality rate of 0.12-0.2%.