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A massive national survey that has regularly measured U.S. public opinion since the start of the pandemic finds that about half of American adults say they have been infected with COVID-19 at some point—considerably more than have reported testing positive. 

The , involving a consortium of scholars at five U.S. universities, has surveyed people across all 50 states and Washington, D.C., on nearly a monthly basis since April 2020. The new report, is based on the latest survey of more than 26,000 people in October and November. 

This was the 96th report issued by the academic team since the project began, based on surveys that have tapped more than 20,000 participants at a time. The latest report steps back and offers an overview on American attitudes and behavior regarding COVID-19 since early 2020, from self-testing to vaccination and mask-wearing.  

Among the core findings: while about half of Americans say they’ve had COVID, just over one-third say they have tested positive for the virus, and many self-tests are going unreported. The study says “the official data are currently missing about 48% of known COVID cases from the last three months.” 

The latest report, produced by faculty members at Harvard Kennedy School, Harvard Medical School, Northeastern University, Northwestern University, and Rutgers, says at least five out of six American adults likely have some level of immunity to COVID-19, either through vaccination or previous infection. 

The top 10 takeaways, as framed in the report’s summary:  

1. About half of American adults surveyed say they have been infected with COVID-19 at some point, with 35% saying they have tested positive for COVID-19 before.  
2. Individuals vaccinated against COVID-19 report being sick for fewer days than unvaccinated individuals.  
3. Due to the underreported use of at-home rapid tests, the data on reported tests are missing a significant number of positive cases.  
4. At least five in six American adults likely have some level of immunity to COVID-19, either through vaccination or previous infection.  
5. A substantial majority of American adults have not received the bivalent booster shot, but a majority of those who have not say they plan to or are open to getting the shot.  
6. Antiviral medications are not being heavily utilized, even among higher risk American adults.  
7. One in nine American adults report having continued symptoms from COVID-19 more than two months post-infection.  
8. Nearly half of American adults are still wearing masks, but only a quarter say they are very closely following the recommendation to wear a mask when outside of the home.  
9. Only 28% of American adults have received their flu shot.  
10. There is a strong correlation between getting the bivalent booster and getting a flu shot. However, just one in 10 American adults have received both shots.  

The principal author on this report was Jonathan Schulman, a doctoral candidate in political science at Northwestern. Two Harvard faculty members are among the principal investigators of the COVID 50 States project: Matthew Baum, the Marvin Kalb Professor of Global Communications at Harvard Kennedy School, based in the Shorenstein Center on Media, Politics and Public Policy; and Roy Perlis, professor of psychiatry at Harvard Medical School and director of the Center for Quantitative Health at Massachusetts General Hospital.  

“One of the more striking findings in our new report is that almost half of likely COVID-19 cases are going undiagnosed by medical professionals and so are not reflected in the case counts we regularly see in the news,” said Baum. “This suggests that while the pandemic remains very much with us, it has in important respects gone underground. The more hopeful news is that over 80% of Americans appear to have some immunity, either from vaccination or prior infection.”  

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Banner photo by Jeff Greenberg/Universal Images Group/Getty Images