The challenge is, as with similar studies, using routinely collected clinical data does not allow for good ascertainment of asymptomatic cases. They had a very useful sensitivity analysis to check this, but even then the inherent selection bias remains
They will be more likely to seek testing than if there's a monetary cost, but the potential for bias is certainly there. Even in vast studies that offer free tests (i.e. ENE-COVID) AND follow people up with multiple phone calls 20-30% of people don't do it
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Also worth considering that for those who work in casual jobs there may be a very direct and large monetary cost to getting a COVID-19 test if they are forced to isolate afterwards. Lots of reasons that people may not be willing to go and get tested especially if they feel fine
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So the alternative is active regular surveillance...of the whole population of Denmark? That doesn’t seem plausible. And if a team went with a subset of Denmark, then they’d be introducing bias.
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No, you could definitely conduct active surveillance without such a massive sample. The REACT-2 study is a beautiful example, although unfortunately they do not always re-test the same individuals over time
End of conversation
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