Evaluating undercounts in epidemics: response to Maruotti et al. 2022

Abstract

Maruotti et al. 2022 used a mark-recapture approach to estimate bounds on the true number of monkeypox infections in various countries. We show that such approaches are fundamentally flawed. We argue on conceptual grounds that it is impossible to estimate undercounting based solely on a single stream of reported cases, supporting our contention by applying the authors' method to simulated epidemics. The simulations show that the proposed methods estimate bounds on the ascertainment ratio of ≈0.2-0.5 roughly independently of the true ascertainment ratio. We conclude that the proposed mark-recapture approach should not be used to estimate undercounting or ascertainment ratios. This article is protected by copyright. All rights reserved.