Critical Care Workers Have Lower Seroprevalence of SARS-CoV-2 IgG Compared with Non-patient Facing Staff in First Wave of COVID19

  1. Helen E. Baxendale
  2. David Wells
  3. Jessica Gronlund
  4. Angalee Nadesalingham
  5. Mina Paloniemi
  6. George Carnell
  7. Paul Tonks
  8. Lourdes Ceron-Gutierrez
  9. Soraya Ebrahimi
  10. Ashleigh Sayer
  11. John A.G. Briggs
  12. Xiaoli Ziong
  13. James A Nathan
  14. Guinevere Grice
  15. Leo C James
  16. Jakub Luptak
  17. Sumita Pai
  18. Jonathan L Heeney
  19. Sara Lear
  20. Rainer Doffinger

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Introduction

In early 2020, at first surge of the coronavirus disease 2019 (COVID-19) pandemic, many health care workers (HCW) were re-deployed to critical care environments to support intensive care teams looking after patients with severe COVID-19. There was considerable anxiety of increased risk of COVID-19 for these staff. To determine whether critical care HCW were at increased risk of hospital acquired infection, we explored the relationship between workplace, patient facing role and evidence of immune exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within a quaternary hospital providing a regional critical care response. Routine viral surveillance was not available at this time.

Methods

We screened over 500 HCW (25% of the total workforce) for history of clinical symptoms of possible COVID19, assigning a symptom severity score, and quantified SARS-CoV-2 serum antibodies as evidence of immune exposure to the virus.

Results

Whilst 45% of the cohort reported symptoms that they consider may have represented COVID-19, 14% had evidence of immune exposure. Staffs in patient facing critical care roles were least likely to be seropositive (9%) and staff working in non-patient facing roles most likely to be seropositive (22%). Anosmia and fever were the most discriminating symptoms for seropositive status. Older males presented with more severe symptoms. Of the 12 staff screened positive by nasal swab (10 symptomatic), 3 showed no evidence of seroconversion in convalescence.

Conclusions

Patient facing staff working in critical care do not appear to be at increased risk of hospital acquired infection however the risk of nosocomial infection from non-patient facing staff may be more significant than previous recognised. Most symptoms ascribed to possible COVID-19 were found to have no evidence of immune exposure however seroprevalence may underrepresent infection frequency. Older male staff were at the greatest risk of more severe symptoms.

Article activity feed

  1. Version published to 10.2478/jccm-2021-0018
  2. ScreenIT

    SciScore for 10.1101/2020.11.12.20145318: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: Following informed consent, staff were invited to complete a questionnaire to clarify whether they had swab PCR confirmed SARS-CoV-2 infection and whether they had experienced symptoms that they felt may have been consistent with COVID-19 since January 2020.
    IRB: The study was approved by Research Ethics Committee Wales, IRAS: 96194 12/WA/0148.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Beads were incubated for 30 min with a PE-labeled anti–human IgG-Fc antibody (Leinco/Biotrend), washed as described above, and resuspended in 100 μl PBS/Tween.
    anti–human IgG-Fc
    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:
    This study has a number of limitations. Most significantly, that nasal swabbing for SARS-CoV-2 PCR tests were not available for symptomatic staff early in the pandemic when most of our staff reported symptoms that they felt may have represented COVID-19. Some care should be taken when interpreting the exact relationship between severity of infection and age of men as relatively few male staff members were classified as seropositive. However, many other studies have similarly reported increased incidence of severe COVID-19 in men especially older men (38, 39) (40) Large cohort, longitudinal studies with paired swab and serum samples additional to symptom reporting are now running. In the UK, the Sarscov2 Immunity & REinfection EvaluatioN longitudinal health care worker surveillance study, SIREN (41) where swab and serum samples are collected at 2-4 weekly intervals in large cohorts, in addition to symptom reporting, will provide the power to define in detail the relationship between serum response, symptom severity and re-infection risk in HCW by demographic. Although it is important to acknowledge that many staff identified as being at increased risk of severe COVID-19 have been shielding and/or working remotely and may be under-represented in these workplace based cohort studies. In conclusion, this data presented suggest: 1. staff working in critical care environments looking after large numbers of COVID-19 patients and those transferring acutely unwell patients for escalat...

    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.

    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 10.1101/2020.11.12.20145318v1 on medRxiv