Seropositivity of COVID-19 among asymptomatic healthcare workers: A multi-site prospective cohort study from Northern Virginia, United States

Abdulla A Damluji; Siqi Wei; Scott A Bruce; Amanda Haymond; Emanuel F Petricoin; Lance Liotta; G Larry Maxwell; Brian C Moore; Rachel Bell; Stephanie Garofalo; Eric R Houpt; David Trump; Christopher R deFilippi

doi:10.1016/j.lana.2021.100030

Seropositivity of COVID-19 among asymptomatic healthcare workers: A multi-site prospective cohort study from Northern Virginia, United States

Lancet Reg Health Am. 2021 Oct:2:100030. doi: 10.1016/j.lana.2021.100030. Epub 2021 Jul 29.

Authors

Affiliations

¹ The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, 3300 Gallows Road, I-465, Falls Church, VA 22042, United States.
² Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
³ Department of Statistics, George Mason University, Fairfax, VA, United States.
⁴ Department of Statistics, Texas A&M University, College Station, TX, United States.
⁵ Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, United States.
⁶ Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United States.
⁷ Virginia Department of Health, Richmond, VA, United States.

Abstract

Background: Because of their direct patient contact, healthcare workers (HCW) face an unprecedented risk of exposure to COVID-19. The aim of this study was to examine incidence of COVID-19 disease among asymptomatic HCW and community participants in Northern Virginia during 6 months of follow-up.

Methods: This is a prospective cohort study that enrolled healthy HCW and residents who never had a symptomatic COVID-19 infection prior to enrolment from the community in Northern Virginia from April to November 2020. All participants were invited to enrol in study, and they were followed at 2-, and 6-months intervals. Participants were evaluated by commercial chemiluminescence SARS-CoV-2 serology assays as part of regional health system and public health surveillance program to monitor the spread of COVID-19 disease.

Findings: Of a total of 1,819 asymptomatic HCW enrolled, 1,473 (96%) had data at two-months interval, and 1,323 (73%) participants had data at 6-months interval. At baseline, 21 (1.15%) were found to have prior COVID-19 exposure. At two-months interval, COVID-19 rate was 2.8% and at six months follow-up, the overall incidence rate increased to 4.8%, but was as high as 7.9% among those who belong to the youngest age group (20-29 years). Seroconversion rates in HCW were comparable to the seropositive rates in the Northern Virginia community. The overall incidence of COVID-19 in the community was 4.5%, but the estimate was higher among Hispanic ethnicity (incidence rate = 15.3%) potentially reflecting different socio-economic factors among the community participants and the HCW group. Using cross-sectional logistic regression and spatio-temporal mixed effects models, significant factors that influence the transmission rate among HCW include age, race/ethnicity, resident ZIP-code, and household exposure, but not direct patient contact.

Interpretation: In Northern Virginia, the seropositive rate of COVID-19 disease among HCW was comparable to that in the community.

Keywords: CIA, Chemiluminescent immunoassay; COVID-19; COVID-19, Coronavirus disease 2019; HCW, Healthcare worker; Immunity; PPE, Personal protective equipment; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; Serologic test; ZIP, Zone Improvement Plan.