Estimating SARS-CoV-2 Seroprevalence

During the COVID-19 pandemic, governments and public health authorities have used seroprevalence studies to estimate the proportion of persons within a given population who have antibodies to SARS-CoV-2. Seroprevalence is crucial for estimating quantities such as the infection fatality ratio, proportion of asymptomatic cases, and differences in infection rates across population subgroups. However, serologic assays are prone to false positives and negatives, and non-probability sampling methods may induce selection bias. In this paper, we consider nonparametric and parametric seroprevalence estimators that address both challenges by leveraging validation data and assuming equal probabilities of sample inclusion within covariate-defined strata. Both estimators are shown to be consistent and asymptotically normal, and consistent variance estimators are derived. Simulation studies are presented comparing the finite sample performance of the estimators over a range of assay characteristics and sampling scenarios. The methods are used to estimate SARS-CoV-2 seroprevalence in asymptomatic individuals in Belgium and North Carolina.