We aimed to ascertain the extent to which active infections are underestimated by case reporting in standard surveillance (i.e., results reported to the state public health agency after testing at a clinic or pharmacy). We measured the point prevalence of self-reported COVID-19 cases among the cohort during the recent Omicron surge. The proportion of study participants with COVID infection at the time of the survey was based on cases identified by PCR and/or rapid antigen tests, which would be captured by standard surveillance, as well as cases exclusively identified by rapid at-home testing and probable cases that had no recent testing history. Our study found that a substantial number of cases would have been missed by standard surveillance. These findings underscore the need for new surveillance approaches to include rapid at-home test results so that we can more accurately gauge SARS-CoV-2 spread in the community and adjust transmission prevention recommendations. For more information, click here.