SARS-CoV-2 active infection prevalence and seroprevalence in the adult population of St. Louis County

Charles W. Goss, Brett B. Maricque, Victoria V. Anwuri, Rachel E. Cohen, Kate Donaldson, Kimberly J. Johnson, William G. Powderly, Kenneth B. Schechtman, Spring Schmidt, Jeannette Jackson Thompson, Anne M. Trolard, Jinli Wang, Elvin H. Geng

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: The true prevalence of COVID-19 is difficult to estimate due to the absence of random population-based testing. To estimate current and past COVID-19 infection prevalence in a large urban area, we conducted a population-based survey in St. Louis County, Missouri. Methods: The population-based survey of active infection (PCR) and seroprevalence (IgG antibodies) of adults (≥18 years) was conducted through random-digit dialing and targeted sampling of St. Louis County residents with oversampling of Black residents. Infection prevalence of residents was estimated using design-based and raking weighting. Results: Between August 17 and October 24, 2020, 1245 residents completed a survey and underwent PCR testing; 1073 residents completed a survey and underwent PCR and IgG testing or self-reported results. Weighted prevalence estimates of residents with active infection were 1.9% (95% CI, 0.4%–3.3%) and 5.6% were ever infected (95% CI, 3.3%–8.0%). Overall infection hospitalization and fatality ratios were 4.9% and 1.4%, respectively. Conclusions: Through October 2020, the percentage of residents that had ever been infected was relatively low. A markedly higher percentage of Black and other minorities compared to White residents were infected with COVID-19. The St. Louis region remained highly vulnerable to widespread infection in late 2020.

Original languageEnglish
Pages (from-to)31-37
Number of pages7
JournalAnnals of Epidemiology
StatePublished - Jul 2022


  • Covid-19
  • Probability survey
  • Seroprevalence


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