sars cov 2 seroprevalence across a diverse cohort of healthcare workers CORD-Papers-2021-10-25 (Version 1)

Title: SARS-CoV-2 Seroprevalence Across a Diverse Cohort of Healthcare Workers
Abstract: Importance: Antibody testing is important for understanding patterns of exposure and potential immunity to SARS-CoV-2. Prior data on seroprevalence have been subject to variations in selection of individuals and nature as well as timing of testing in relation to exposures. Objective: We sought to determine the extent of SARS-CoV-2 seroprevalance and the factors associated with seroprevelance across a diverse cohort of healthcare workers. Design: Observational cohort study of healthcare workers, including SARS-CoV-2 serology testing and participant questionaires. Participants: A diverse and unselected population of adults (n=6,062) employed in a multi-site healthcare delivery system located in Los Angeles County, including individuals with direct patient contact and others with non-patient-oriented work functions. Exposure: Exposure and infection with the SARS-CoV-2 virus, as determined by seropositivity. Main Outcomes: Using Bayesian and multi-variate analyses, we estimated seroprevalence and factors associated with seropositivity and antibody titers, including pre-existing demographic and clinical characteristics; potential Covid-19 illness related exposures; and, symptoms consistent with Covid-19 infection. Results: We observed a seroprevalence rate of 4.1%, with anosmia as the most prominently associated self-reported symptom in addition to fever, dry cough, anorexia, and myalgias. After adjusting for potential confounders, pre-existing medical conditions were not associated with antibody positivity. However, seroprevalence was associated with younger age, Hispanic ethnicity, and African-American race, as well as presence of either a personal or household member having a prior diagnosis of Covid-19. Importantly, African American race and Hispanic ethnicity were associated with antibody positivity even after adjusting for personal Covid-19 diagnosis status, suggesting the contribution of unmeasured structural or societally factors. Notably, number of people, or children, in the home was not associated with antibody positivity. Conclusion and Relevance: The demographic factors associated with SARS-CoV-2 seroprevalence among our healthcare workers underscore the importance of exposure sources beyond the workplace. The size and diversity of our study population, combined with robust survey and modeling techniques, provide a vibrant picture of the demographic factors, exposures, and symptoms that can identify individuals with susceptibility as well as potential to mount an immune response to Covid-19.
Published: 8/4/2020
DOI: 10.1101/2020.07.31.20163055
DOI_URL: http://doi.org/10.1101/2020.07.31.20163055
Author Name: Ebinger, J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/ebinger_j
Author Name: Botwin, G J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/botwin_g_j
Author Name: Albert, C M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/albert_c_m
Author Name: Alotaibi, M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/alotaibi_m
Author Name: Arditi, M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/arditi_m
Author Name: Berg, A H
Author link: https://covid19-data.nist.gov/pid/rest/local/author/berg_a_h
Author Name: Binek, A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/binek_a
Author Name: Botting, P G
Author link: https://covid19-data.nist.gov/pid/rest/local/author/botting_p_g
Author Name: Fert Bober, J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/fert_bober_j
Author Name: Figueiredo, J C
Author link: https://covid19-data.nist.gov/pid/rest/local/author/figueiredo_j_c
Author Name: Grein, J D
Author link: https://covid19-data.nist.gov/pid/rest/local/author/grein_j_d
Author Name: Hasan, W
Author link: https://covid19-data.nist.gov/pid/rest/local/author/hasan_w
Author Name: Henglin, M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/henglin_m
Author Name: Hussain, S K
Author link: https://covid19-data.nist.gov/pid/rest/local/author/hussain_s_k
Author Name: Jain, M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/jain_m
Author Name: Joung, S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/joung_s
Author Name: Karin, M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/karin_m
Author Name: Kim, E H
Author link: https://covid19-data.nist.gov/pid/rest/local/author/kim_e_h
Author Name: Li, D
Author link: https://covid19-data.nist.gov/pid/rest/local/author/li_d
Author Name: Liu, Y
Author link: https://covid19-data.nist.gov/pid/rest/local/author/liu_y
Author Name: Luong, E
Author link: https://covid19-data.nist.gov/pid/rest/local/author/luong_e
Author Name: McGovern, D P B
Author link: https://covid19-data.nist.gov/pid/rest/local/author/mcgovern_d_p_b
Author Name: Merchant, A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/merchant_a
Author Name: Merin, N M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/merin_n_m
Author Name: Miles, P B
Author link: https://covid19-data.nist.gov/pid/rest/local/author/miles_p_b
Author Name: Minissian, M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/minissian_m
Author Name: Nguyen, T T
Author link: https://covid19-data.nist.gov/pid/rest/local/author/nguyen_t_t
Author Name: Raedschelders, K
Author link: https://covid19-data.nist.gov/pid/rest/local/author/raedschelders_k
Author Name: Rashid, M A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/rashid_m_a
Author Name: Riera, C E
Author link: https://covid19-data.nist.gov/pid/rest/local/author/riera_c_e
Author Name: Riggs, R V
Author link: https://covid19-data.nist.gov/pid/rest/local/author/riggs_r_v
Author Name: Sharma, S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/sharma_s
Author Name: Sternbach, S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/sternbach_s
Author Name: Sun, N
Author link: https://covid19-data.nist.gov/pid/rest/local/author/sun_n
Author Name: Tourtellotte, W G
Author link: https://covid19-data.nist.gov/pid/rest/local/author/tourtellotte_w_g
Author Name: Van Eyk, J E
Author link: https://covid19-data.nist.gov/pid/rest/local/author/van_eyk_j_e
Author Name: Sobhani, K
Author link: https://covid19-data.nist.gov/pid/rest/local/author/sobhani_k
Author Name: Braun, J G
Author link: https://covid19-data.nist.gov/pid/rest/local/author/braun_j_g
Author Name: Cheng, S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/cheng_s
sha: d8ddfef3f0358553cdf1330282c734c0611f301c
license: medrxiv
source_x: MedRxiv; WHO
source_x_url: https://www.who.int/
url: http://medrxiv.org/cgi/content/short/2020.07.31.20163055v1?rss=1 https://doi.org/10.1101/2020.07.31.20163055
has_full_text: TRUE
Keywords Extracted from Text Content: anorexia SARS-CoV-2 ABSTRACT SARS-CoV-2 IgG n=6,062 Covid-19 Los Angeles patient nucleocapsid sera self-isolate SARS-CoV-2 IgG antibody California IPF reactive airway Covid-19 N=6,318 Pathology anorexia Covid-19 antibody SARS-CoV-2 IgM antibodies peripheral venous N=6,062 P<0.10 participants ≥ 7 children 2,114 tests dogs Supplemental Table 6 IgG antibodies anti-human IgG SARS-CoV-2 IgG cats cell specimens IL Los Angeles patient chills RStan people employees microparticle Figure 1 anti-SARS-CoV-2 antibodies SARS-CoV-2 virus persons patients renal inpatients S/CO IgG thse SARS-CoV-2 antibody patients
Extracted Text Content in Record: First 5000 Characters:What is the SARS-CoV-2 IgG seroprevalence rate across a large and diverse healthcare worker population, and which clinical, envionrmental, and symptom-based measures are associated with seropositivity? Findings: We observed a seroprevalence rate of 4.1%. Adjusting for potential confounders, seropositivity was associated with younger age, Hispanic ethnicity, African-American race, and the symptom of anosmia, while not significantly associated with any pre-existing medical conditions. Meaning: Factors associated with SARS-CoV-2 seroprevalence among our healthcare workers underscore the importance of exposure sources beyond the workplace. ABSTRACT Importance: Antibody testing is important for understanding patterns of exposure and potential immunity to SARS-CoV-2. Prior data on seroprevalence have been subject to variations in selection of individuals and nature as well as timing of testing in relation to exposures. Objective: We sought to determine the extent of SARS-CoV-2 seroprevalance and the factors associated with seroprevelance across a diverse cohort of healthcare workers. Design: Observational cohort study of healthcare workers, including SARS-CoV-2 serology testing and participant questionaires. A diverse and unselected population of adults (n=6,062) employed in a multi-site healthcare delivery system located in Los Angeles County, including individuals with direct patient contact and others with non-patient-oriented work functions. Main Outcomes: Using Bayesian and multi-variate analyses, we estimated seroprevalence and factors associated with seropositivity and antibody titers, including pre-existing demographic and clinical characteristics; potential Covid-19 illness related exposures; and, symptoms consistent with Covid-19 infection. We observed a seroprevalence rate of 4.1%, with anosmia as the most prominently associated self-reported symptom in addition to fever, dry cough, anorexia, and myalgias. After adjusting for potential confounders, pre-existing medical conditions were not associated with antibody positivity. However, seroprevalence was associated with younger age, Hispanic ethnicity, and African-American race, as well as presence of either a personal or household member having a prior diagnosis of Covid-19. Importantly, African American race and Hispanic ethnicity were associated with antibody positivity even after adjusting for personal diagnosis status, suggesting the contribution of unmeasured structural or societally factors. Notably, number of people, or children, in the home was not associated with antibody positivity. The demographic factors associated with SARS-CoV-2 seroprevalence among our healthcare workers underscore the importance of exposure sources beyond the workplace. The size and diversity of our study population, combined with robust survey and modeling techniques, provide a vibrant picture of the demographic factors, exposures, and symptoms that can identify individuals with susceptibility as well as potential to mount an immune response to Covid-19. Amidst the ongoing global pandemic caused by SARS-CoV-2, the viral agent causing Covid-19, substantial attention 1 turned to antibody testing as an approach to understanding patterns of exposure and immunity across populations. The use and interpretion of antibody testing to assess exposure and immunity remains frought with inconsistencies and unclear clinical correlations, in part due to a dearth of high quality studies among diverse participants. 2, 3 Recent publications have pointed to the challenges and importance of understanding how different antibody tests for SARS-CoV-2 perform, and factors that may render one method superior to another. 4, 5 Nonetheless, there remains general agreement that antibody testing offers valuable information regarding the probable extent of SARS-CoV-2 exposure, the factors associated with exposure, and the potential nature and determinants of seropositive status. 6 To the end, we conducted a study of SARS-CoV-2 antibody screening of a large, diverse, and unselected population of adults employed in a multi-site healthcare delivery system located in Los Angeles County, including individuals with direct patient contact and others with nonpatient-oriented work functions. Recognizing the range of factors that might influence antibody status in a given individual, we focused our study on not only estimating seroprevalence but also on identifying factors associated with seropositivity and relative antibody levels within the following three categories: (1) pre-existing demographic and clinical characteristics; (2) potential Covid-19 illness related exposures; and, (3) Covid-19 illness related response variables (i.e. different types of self-reported symptoms). The sampling strategy for our study has been described previously. 7 In brief, beginning on May 11, 2020, we enrolled a total of N=6,318 active employees working at multiple sites comprising the Cedars-Sinai Health System, located in t
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