Risk Factors for SARS-CoV-2 Seropositivity in a Health Care Worker Population
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Abstract
Background
Protecting health care workers (HCWs) during the coronavirus disease 2019 (COVID-19) pandemic is essential. Serologic testing can identify HCWs who had minimally symptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections that were missed by occupational screening based on daily symptom and temperature checks. Recent studies report conflicting results regarding the impact of occupational factors on SARS-CoV-2 seropositivity amongst HCWs.
Methods
The study population included all hospital workers at an academic medical center in Orange County, California. SARS-CoV-2 seropositivity was assessed from a fingerstick blood specimen using a coronavirus antigen microarray, which compares IgM and IgG antibodies against a panel of SARS-CoV-2 antigens with positive and negative controls to identify prior SARS-CoV-2 infection with 98% specificity and 93% sensitivity. Demographic, occupational, and clinical factors were surveyed and their effect on seropositivity estimated using multivariable logistic regression analysis.
Results
Amongst 1,557 HCWs with complete data, SARS-CoV-2 seropositivity was 10.8%. Risk factors for increased seropositivity included male gender, exposure to COVID-19 outside of work, working in food or environmental services, and working in COVID-19 units. Amongst the 1,103 HCW who were seropositive but missed by occupational screening, additional risk factors included younger age and working in administration.
Conclusions
SARS-CoV-2 seropositivity is significantly higher than reported case counts even amongst HCWs who are meticulously screened. Seropositive HCWs missed by occupational screening were more likely to be younger, work roles without direct patient care, or have COVID-19 exposure outside of work.
Key Points
SARS-CoV-2 seropositivity risk factors amongst health care workers included male gender, nonoccupational exposure, food or environmental services role, and COVID-19 unit location. Those missed by occupational screening were younger, in roles without direct patient care, or exposed outside of work.
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SciScore for 10.1101/2020.12.17.20248430: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Study Design, Setting, and Population: The study was approved by the Institutional Review Board of the University of California-Irvine under Protocol HS 2020-5818.
Consent: A primary study site in the main hospital building was open from May 15 to May 29, 2020 to all employees who provided electronic consent (open enrollment cohort).Randomization d) post-symptom onset and 88 pre-pandemic controls with blood collected prior to November 1, 2019, which were split randomly into 70% derivation and 30% validation cohorts. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resour… SciScore for 10.1101/2020.12.17.20248430: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Study Design, Setting, and Population: The study was approved by the Institutional Review Board of the University of California-Irvine under Protocol HS 2020-5818.
Consent: A primary study site in the main hospital building was open from May 15 to May 29, 2020 to all employees who provided electronic consent (open enrollment cohort).Randomization d) post-symptom onset and 88 pre-pandemic controls with blood collected prior to November 1, 2019, which were split randomly into 70% derivation and 30% validation cohorts. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Study Procedures: Participants were given a unique study identifier and a mobile phone link to a Research Electronic Data Capture (REDCap, Vanderbilt University, Nashville, TN) survey to collect data on demographic, clinical, and occupational risk factors (Appendix A). REDCapsuggested: (REDCap, RRID:SCR_003445)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:Stratification of HCWs based on whether or not they were tested previously by rt-PCR yielded several additional insights into the strengths and weaknesses of universal symptom screening. The association between COVID-19 symptoms and seropositivity was restricted to HCW tested previously by rt-PCR, indicating that universal screening was effective in identifying symptomatic infections. Younger HCWs who were COVID-19-seropositive were more likely to be missed by occupational screening, which is consistent with the increased prevalence of minimally symptomatic infection among younger individuals[27]. Decreased seropositivity among HCW in labor and delivery units may be due to increased vigilance amongst HCW who care for pregnant patients or low disease prevalence among these patients. While the hospital’s mandatory screening was only implemented one month prior to this study, the prevalence of COVID-19 in Orange County was low at that time and increased subsequently (Figure 2). The CoVAM was trained and validated on blood specimens collected relatively soon after symptom onset (minimum 7 d, median 11 d) consistent with known kinetics of the antibody response to COVID-19 [3]. Therefore, we believe the effects of occupational health screening are at least partially captured in our analysis. In addition, the study hospital was able to maintain infection prevention best practices consistent with guidance from the U.S. Centers for Disease Control and Prevention (CDC), including conti...
Results from TrialIdentifier: No clinical trial numbers were referenced.
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.
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