Prospective SARS-CoV-2 cohort study among primary health care providers during the second COVID-19 wave in Flanders, Belgium

  1. Joachim Mariën
  2. Ann Ceulemans
  3. Diana Bakokimi
  4. Christine Lammens
  5. Margareta Ieven
  6. Stefan Heytens
  7. An De Sutter
  8. Jan Y Verbakel
  9. Ann Van den Bruel
  10. Herman Goossens
  11. Pierre Van Damme
  12. Kevin K Ariën
  13. Samuel Coenen

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Abstract

Background

Primary health care providers (PHCPs) are assumed to be at high risk of a COVID-19 infection, as they are exposed to patients with usually less personal protective equipment (PPE) than other frontline health care workers (HCWs). Nevertheless, current research efforts focussed on the assessment of COVID-19 seroprevalence rates in the general population or hospital HCWs.

Objective

We aimed to determine the seroprevalence in PHCPs during the second SARS-CoV-2 wave in Flanders (Belgium) and compared it to the seroprevalence in the general population. We also assessed risk factors, availability of PPE and attitudes towards the government guidelines over time.

Methods

A prospective cohort of PHCPs (n = 698), mainly general practitioners, was asked to complete a questionnaire and self-sample capillary blood by finger-pricking at five distinct points in time (June–December 2020). We analysed the dried blood spots for IgG antibodies using a Luminex multiplex immunoassay.

Results

The seroprevalence of PHCPs remained stable between June and September (4.6–5.0%), increased significantly from October to December (8.1–13.4%) and was significantly higher than the seroprevalence of the general population. The majority of PHCPs were concerned about becoming infected, had adequate PPE and showed increasing confidence in government guidelines.

Conclusions

The marked increase in seroprevalence during the second COVID-19 wave shows that PHCPs were more at risk during the second wave compared to the first wave in Flanders. This increase was only slightly higher in PHCPs than in the general population suggesting that the occupational health measures implemented provided sufficient protection when managing patients.

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  1. Version published to 10.1093/fampra/cmab094
  2. ScreenIT

    SciScore for 10.1101/2021.03.26.21254327: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Participants that provided written informed consent were asked to self-sample capillary blood by fingerpicking and to complete a baseline questionnaire through an online secured application (basic socio-demographics, health status, the availability and implementation of preventive measures) at five different time-points (June-September-October-November and December 2020).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Laboratory: All dried blood spots (DBS) were analysed for the presence of anti-SARS-CoV-2 IgG antibodies at the Institute of Tropical Medical in Antwerp using an in-house Luminex multiplex immunoassay (MIA), which is described in detail in Mariën et al 2020 (8).
    anti-SARS-CoV-2 IgG
    suggested: None
    These samples were screened on SARS-Cov-2 IgG antibodies using the EuroImmun (June and September) or Wantai (November-December) SARS-CoV-2 antibody ELISAs.
    SARS-CoV-2
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Indeed, a limitation of our study is that we could not directly compare the seroprevalence of PHCPs to blood donors because samples were different (capillary vs venous blood), stored differently (DBS vs serum tube) and analysed with different techniques (Luminex MIA versus ELISA). We chose DBS sampling because of its convenience of non-invasive sampling and room-temperature storage. Serological point-of-care tests (POCTs) would have substantially improved the timeliness of the test results and the PHCPs could have immediately checked their results (13). We did not use POCTs in this study because of limited resources and particularly since their specificity was not good enough at the time we conceived this study. Nonetheless, our study suggests that DBS sampling is a useful alternative for SARS-CoV-2 serosurveillance in nonclinical, resource-limited settings. Samples can also be reused (e.g. to check for co-infections), which is impossible with POCTs. In conclusion, the steep increase in seroprevalence during the second COVID-19 wave indicates that PHCPs were more at risk during the second wave compared to the first wave in Flanders. Although we could not verify if an infection occurred at work or at home, the slightly higher incidence (insignificant) of PHCPs compared to blood donors suggests that only a minority of GPs became infected when managing patients. This suggests that GPs were relatively well protected during the second COVID-19 wave or that close contacts with infe...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04779424Active, not recruitingPrevalence and Incidence of Antibodies Against SARS-CoV-2 Am…
    NCT04373889Active, not recruitingCOVID-19 Among Healthcare Workers in Belgian Hospitals

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.03.26.21254327v1 on medRxiv