SARS-CoV-2 Seroprevalence Among First Responders in Northeastern Ohio, 2020

  1. Xiaochun Zhang
  2. Elie Saade
  3. Jaime H. Noguez
  4. Christine Schmotzer

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Abstract

First responders, including firefighters, emergency medical technicians (EMTs), paramedics, and law enforcement officers, are working on the front lines to fight the COVID-19 pandemic and facing an increased risk of infection. This study assessed the seroprevalence of SARS-CoV-2 infection among first responders in northeastern Ohio.

Methods:

A survey and immunoglobulin G antibody test against SARS-CoV-2 nucleocapsid protein were offered to University Hospitals Health System–affiliated first-responder departments during May to September 2020. The survey contained questions about demographic characteristics and history of SARS-CoV-2 infection. A total of 3080 first responders with diverse job assignments from more than 400 fire and police departments participated in the study.

Results:

Of 3080 participants, 73 (2.4%) were seropositive and 26 (0.8%) had previously positive real-time polymerase chain reaction results. Asymptomatic infection accounted for 46.6% (34 of 73) of seropositivity. By occupation, rates of seropositivity were highest among administration/support staff (3.8%), followed by paramedics (3.0%), EMTs (2.6%), firefighters (2.2%), and law enforcement officers (0.8%). Work-associated exposure rates to COVID-19 patients were: paramedics (48.2%), firefighters (37.1%), EMTs (32.3%), law enforcement officers (7.7%), and administration/support staff (4.4%). Self-reported community exposure was positively correlated with self-reported work-associated exposure rate (correlation coefficient = 0.99). Neither self-reported community nor work-associated exposure was correlated with SARS-CoV-2 seroprevalence. We found no significant difference in seroprevalence among sex/gender or age groups; however, Black participants had a higher positivity rate than participants of other racial groups despite reporting lower exposure.

Conclusions:

Despite the high work-associated exposure rate to SARS-CoV-2 infection, first responders with various roles demonstrated seroprevalence no higher than their administrative/supportive colleagues, which suggests infection control measures are effective in preventing work-related infection.

Article activity feed

  1. Version published to 10.1177/00333549221119143
  2. ScreenIT

    SciScore for 10.1101/2021.06.27.21259432: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: Study design and participants: The study was reviewed and approved by the University Hospitals Health System (UHHS) institutional review board.
    Consent: Informed consent, survey and study workflow: Participants were requested to provide informed consent, complete a survey, and get a single blood draw by venipuncture.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    REDCap (Research Electronic Data Capture), a secure web application, was used for administering informed consent forms electronically, managing the surveys, and storing COVID antibody results.
    REDCap
    suggested: (REDCap, RRID:SCR_003445)
    The testing was performed using the Abbott SARS-CoV-2 IgG assay, a chemiluminescent microparticle immunoassay on Architect i1000SR analyzers for detecting IgG antibodies against the nucleocapsid protein of SARS-CoV-2.
    Abbott
    suggested: (Abbott, RRID:SCR_010477)
    The SigmaPlot software automatically analyzes data for its suitability for Chi-Square or Fisher’s exact test and suggests the appropriate test based on the sample size of each group.
    SigmaPlot
    suggested: (SigmaPlot, RRID:SCR_003210)

    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:
    Despite their limitations, serological tests are important tools for assessing SARS-CoV-2 infection and potential immunity. Fifty-six antibody assays have received emergency use authorization (EUA) from the Food and Drug Administration (FDA) by December 20, 2020. In general, lab-based assays, especially chemiluminescent microparticle immunoassay assay performed on fully automated analyzers, have higher specificity compared to rapid tests (later flow immunoassay) according to the performance characteristics shown on the FDA webpage (https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/eua-authorized-serology-test-performance). Assay specificity is critical in reducing false-positive rates for large scale survey in low prevalence population. Per the manufacturer’s package insert, the assay used in this study was estimated to have 100% sensitivity (>14 days post-symptom onset) and 99.6% specificity. An independent evaluation study by Bryan et al also confirmed excellent specificity (99.9%) of this assay 8. The estimated Positive Predictive Value and Negative Predictive Value at a prevalence of 5% were calculated to be 93.4% and 100%, respectively. By occupation, paramedics, EMTs, and firefighters showed similar seropositivity rates around 2-3%. The positivity rates are slightly lower than administrative or support staff. Analysis of self-reported exposure confirmed the high-risk nature of these occupations had signifi...

    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.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.06.27.21259432v1 on medRxiv