A cross-sectional study of immune seroconversion to SARS-CoV-2 in frontline maternity health professionals

Prevalence of COVID-19 in medical school and residency in Porto Alegre, RS

OBJECTIVE

A multicentric, cross-sectional study was carried out to determine the prevalence and risk factors for Coronavirus disease 2019 in medical students and residents from four universities and affiliated hospitals in Brazil.

METHODS

A survey about contamination risk and symptoms was sent to all participants through email and WhatsApp. Prevalence was measured by the self-report of positive polymerase chain reaction or serological test. Univariate and multivariate analyses were performed, and odds ratio and 95% confidence interval were calculated.

RESULTS

Prevalence of infection by Sars-CoV-2 was 14.9% (151/1011). The disease was more prevalent in residents and interns than in undergraduate students. Contact with an infected relative outside the hospital or with colleagues without using personal protective equipment was associated with higher contamination. Contact with patients without wearing goggles and higher weekly frequency of contact were the two factors independently associated with the infection by Coronavirus disease 2019 in the multivariate analysis.

CONCLUSIONS

Medical students, interns, and residents have a higher prevalence of Coronavirus disease 2019 than the general population, in which the last two groups are significantly at higher risk. Contacting patients at a higher weekly frequency increases the risk for infection. The use of goggles should be reinforced when contacting patients.

A Prospective, Longitudinal Evaluation of SARS-CoV-2 COVID-19 Exposure, Use of Protective Equipment and Social Distancing in a Group of Community Physicians

Introduction: Healthcare workers experience a significant risk of exposure to and infection from SARS-CoV-2, COVID-19. Nonetheless, little research has focused on physicians’ use of personal protective equipment (PPE), their concerns about becoming infected and their social distancing maneuvers. Methods: All staff physicians at Advocate Lutheran General Hospital were invited to participate. Their COVID-19 IgG antibody level was measured and an online questionnaire was completed. The questionnaire assessed the risk of COVID-19 exposure, PPE usage, concern for contracting COVID-19, the performance of high-risk procedures, work in high-risk settings, and social distancing practices. Testing was performed in September (T0), and December 2020 (T1) at the height of the global pandemic. Results: A total of 481 (26.7%) of 1800 AGLH physicians were enrolled at T0 and 458 (95% of the original group) at T1. A total of 21 (4.3%) and 39 (8.5%) participants had antibodies at T0 and T1. A total of 63 (13.8%) worked in high-risk settings and 111 (24.2%) performed high-risk procedures. Participants working in high-risk settings had increased exposure to COVID-19 infected patients (OR = 4.464 (CI = 2.522–8.459, p < 0.001). Participants were highly adherent to the use of PPE and social distancing practices including mask-wearing in public (86%, 82.1%), avoiding crowds (85.1%, 85.6%), six feet distancing (83.8%, 83.4%), and avoiding public transportation (78%, 83.8%). A total of 251 (55.4%) participants expressed moderate to extreme concern about becoming infected with COVID-19. Conclusions and Relevance: Among a group of community physicians, consistent PPE use and social distancing practices were common. These practices were associated with a low level of initial acquisition of COVID-19 infections and a relatively low longitudinal risk of infection.

Systematic review of productivity loss among healthcare workers due to Covid-19

Objective

To assess existing evidence on the effects of COVID‐19 on healthcare workers (HCWs) using the health‐related productivity loss approach.

Methods

A systematic search of online databases including PubMed, Scopus, Ovid, Web of Science, and EMBASE was conducted up to 25 August 2020. Following two screening stages, studies related to the effects of COVID‐19 on healthcare workers were included in the study.

Results

82 studies were included in the analysis. The COVID‐19 related death rate among HCWs ranged from 0.00‐0.7%, while the positive test incidence varied between 0.00 and 24.4%. 39 evidences assessed psychological disorders. A wide range of psychological disorders observed among HCWs: 5.2 to 71.2% in anxiety, 1.00 to 88.3% in stress, 8.27 to 61.67% in insomnia, and 4.5 to 50.4% in depression.

Conclusions

The early evidence suggests that healthcare workers are one of the most vulnerable groups when it comes to positive COVID‐19 infection, mortality, and mental illness.

Association between SARS-CoV-2 exposure and antibody status among healthcare workers in two London hospitals: a cross-sectional study

BACKGROUND

Patient-facing (frontline) health-care workers (HCWs) are at high risk of repeated exposure to SARS-CoV-2.

AIM

We sought to determine the association between levels of frontline exposure and likelihood of SARS-CoV-2 seropositivity amongst HCW.

METHODS

A cross-sectional study was undertaken using purposefully collected data from HCWs at two hospitals in London, United Kingdom (UK) over eight weeks in May-June 2020. Information on sociodemographic, clinical and occupational characteristics was collected using an anonymised questionnaire. Serology was performed using split SARS-CoV-2 IgM/IgG lateral flow immunoassays. Exposure risk was categorised into five pre-defined ordered grades. Multivariable logistic regression was used to examine the association between being frontline and SARS-CoV-2 seropositivity after controlling for other risks of infection.

FINDINGS

615 HCWs participated in the study. 250/615 (40.7%) were SARS-CoV-2 IgM and/or IgG positive. After controlling for other exposures, there was non-significant evidence of a modest association between being a frontline HCW (any level) and SARS-CoV-2 seropositivity compared to non-frontline status (OR 1.39, 95% CI 0.84-2.30, P=0.200). There was 15% increase in the odds of SARS-CoV-2 seropositivity for each step along the frontline exposure gradient (OR 1.15, 95% CI 1.00-1.32, P=0.043).

CONCLUSION

We found a high SARS-CoV-2 IgM/IgG seropositivity with modest evidence for a dose-response association between increasing levels of frontline exposure risk and seropositivity. Even in well-resourced hospital settings, appropriate use of personal protective equipment, in addition to other transmission-based precautions for inpatient care of SARS-CoV-2 patients could reduce the risk of hospital-acquired SARS-CoV-2 infection among frontline HCW.

COVID-19 in otolaryngologists: a cross-sectional multicenter study

INTRODUCTION

The nose and throat are areas of high viral load, which could place otolaryngologists at an even higher risk for COVID-19 than other health-care workers.

OBJECTIVE

To investigate the prevalence of antibodies against SARS-CoV-2 in otorhinolaryngologists in southern Brazil, its relationship to demographic data, professional practice and reported symptoms of COVID-19, and compare it with official data on other health-care workers of the state and the general population in the same period.

METHODS

In this cross-sectional multicenter study, otolaryngologists actively practicing officially registered in Rio Grande do Sul were screened for IgM and IgG antibodies against SARS-CoV-2 from August 1 to September 15, 2020. A questionnaire was also applied.

RESULTS

We screened 358 (80.1%) of 447 actively practicing otolaryngologists (195 [54.5%] male; mean [SD] age, 47.77 [13.57] years; range, 26-84 years). Twenty-three were positive for IgM and/or IgG (6.4%). This result was significantly associated with reports of infected household contacts (19/315 negatives and 8/23 positives; p < 0.001). From 23 seropositive participants, 14 were asymptomatic (60.9%; p < 0.001). There were no significant associations between seroconversion and age, sex, number of patient appointments and surgical procedures, workplace (hospital or private practice), patients with or without respiratory symptoms, or level of personal protective equipment used. The rate of COVID-19 in all health-care workers in the state was 7.69% at the end of the same period. Data from state government seroprevalence was 5.26 (risk ratio [RR]; 95% CI 3.27-8.45) and 4.66 (RR; 95% CI 2.93-7.43) times higher in otolaryngologists than in the general population in August and September, respectively.

CONCLUSION

Otolaryngologists had a higher seroconversion rate than the general population. Using personal protective equipment, the level of occupational exposure did not result in higher rates of infection than other health-care workers, but the presence of infected household contacts was associated with higher rates of seroconversion.

The next-generation coronavirus diagnostic techniques with particular emphasis on the SARS-CoV-2

The potential zoonotic coronaviruses (SARS-CoV, MERS-CoV, and SARS-CoV-2) are of global health concerns. Early diagnosis is the milestone in their mitigation, control, and eradication. Many diagnostic techniques are showing great success and have many advantages, such as the rapid turnover of the results, high accuracy, and high specificity and sensitivity. However, some of these techniques have several pitfalls if samples were not collected, processed, and transported in the standard ways and if these techniques were not practiced with extreme caution and precision. This may lead to false-negative/positive results. This may affect the downstream management of the affected cases. These techniques require regular fine-tuning, upgrading, and optimization. The continuous evolution of new strains and viruses belong to the coronaviruses is hampering the success of many classical techniques. There are urgent needs for next generations of coronaviruses diagnostic assays that overcome these pitfalls. This new generation of diagnostic tests should be able to do simultaneous, multiplex, and high-throughput detection of various coronavirus in one reaction. Furthermore, the development of novel assays and techniques that enable the in situ detection of the virus on the environmental samples, especially air, water, and surfaces, should be given considerable attention in the future. These approaches will have a substantial positive impact on the mitigation and eradication of coronaviruses, including the current SARS-CoV-2 pandemic.

SARS-CoV-2 in eight municipalities of the Colombian tropics: high immunity, clinical and sociodemographic outcomes

Background

Serological evaluation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an alternative that allows us to determine the prevalence and dynamics of this infection in populations. The goal of this study was to determine the clinical and sociodemographic dynamics of SARS-CoV-2 infection in a region of the Colombian Caribbean.

Methods

Between July and November 2020, a cross-sectional observational study was carried out in Córdoba, located in northeast Colombia in the Caribbean area. Eight municipalities with the largest populations were chosen and 2564 blood samples were taken. A commercial enzyme-linked immunosorbent assay was used with the recombinant protein antigen N of SARS-CoV-2. The people included in the study were asked for sociodemographic and clinical data, which were analysed by statistical methods.

Results

A seroprevalence of 40.8% was obtained for SARS-CoV-2 in the Córdoba region. In the bivariate analysis, no differences were observed in seropositivity against SARS-CoV-2 for gender or age range (p>0.05). Higher seropositivity was found in low socio-economic status and symptomatic patients (p<0.0001). A total of 30.7% of the asymptomatic patients were seropositive for SARS-CoV-2, which could be linked to the spread of this infection. In the multivariate analysis, seroconversion was related to poverty and clinical manifestations such as anosmia and ageusia (p<0.05).

Conclusions

The high seropositivity in Córdoba is due to widespread SARS-CoV-2 in this population. The relationship between seropositivity and socio-economic status suggests a higher exposure risk to the virus caused by informal economic activities in low-income groups. Clinical manifestations such as anosmia and ageusia could be clinical predictors of infection by the new emergent coronavirus.

Management of maternal COVID-19: considerations for anesthesiologists

PURPOSE OF REVIEW

To describe updates to pragmatic recommendations that were published during the first coronavirus disease 2019 (COVID-19) surge, including the current thinking about whether pregnancy worsens the severity of COVID-19.

RECENT FINDINGS

Although a majority of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain asymptomatic or paucisymptomatic, pregnancy puts women at higher risk of severe COVID-19 and adverse birth outcomes. Pregnant and recently pregnant women are more likely to be admitted to intensive care units and receive mechanical ventilation than nonpregnant patients with COVID-19, although preexisting maternal comorbidities are significant risk factors.Early provision of neuraxial labor analgesia with a functional indwelling epidural catheter has been universally promoted, with the goal to reduce avoidable general anesthesia for cesarean delivery and mitigate risks for healthcare workers during airway manipulation. This recommendation, along with updated workflow models of anesthesia coverage, may contribute to a reduction in general anesthesia rates.

SUMMARY

Initial recommendations to provide early neuraxial labor analgesia and avoid general anesthesia for cesarean delivery have not changed over time. Although workflows have significantly changed to allow continued patient and healthcare workers' safety, clinical anesthesia protocols for labor and delivery are essentially the same.

The Proportion of SARS-CoV-2 Infections That Are Asymptomatic : A Systematic Review

BACKGROUND

Asymptomatic infection seems to be a notable feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen that causes coronavirus disease 2019 (COVID-19), but the prevalence is uncertain.

PURPOSE

To estimate the proportion of persons infected with SARS-CoV-2 who never develop symptoms.

DATA SOURCES

Searches of Google News, Google Scholar, medRxiv, and PubMed using the keywords antibodies, asymptomatic, coronavirus, COVID-19, PCR, seroprevalence, and SARS-CoV-2.

STUDY SELECTION

Observational, descriptive studies and reports of mass screening for SARS-CoV-2 that were either cross-sectional or longitudinal in design; were published through 17 November 2020; and involved SARS-CoV-2 nucleic acid or antibody testing of a target population, regardless of current symptomatic status, over a defined period.

DATA EXTRACTION

The authors collaboratively extracted data on the study design, type of testing performed, number of participants, criteria for determining symptomatic status, testing results, and setting.

DATA SYNTHESIS

Sixty-one eligible studies and reports were identified, of which 43 used polymerase chain reaction (PCR) testing of nasopharyngeal swabs to detect current SARS-CoV-2 infection and 18 used antibody testing to detect current or prior infection. In the 14 studies with longitudinal data that reported information on the evolution of symptomatic status, nearly three quarters of persons who tested positive but had no symptoms at the time of testing remained asymptomatic. The highest-quality evidence comes from nationwide, representative serosurveys of England (n = 365 104) and Spain (n = 61 075), which suggest that at least one third of SARS-CoV-2 infections are asymptomatic.

LIMITATION

For PCR-based studies, data are limited to distinguish presymptomatic from asymptomatic infection. Heterogeneity precluded formal quantitative syntheses.

CONCLUSION

Available data suggest that at least one third of SARS-CoV-2 infections are asymptomatic. Longitudinal studies suggest that nearly three quarters of persons who receive a positive PCR test result but have no symptoms at the time of testing will remain asymptomatic. Control strategies for COVID-19 should be altered, taking into account the prevalence and transmission risk of asymptomatic SARS-CoV-2 infection.

PRIMARY FUNDING SOURCE

National Institutes of Health.

Seroprevalence of SARS-CoV-2 IgG antibodies among health care workers prior to vaccine administration in Europe, the USA and East Asia: A systematic review and meta-analysis

BACKGROUND

Knowing the seroprevalence of SARS-CoV-2 IgG antibodies across geographic regions before vaccine administration is one key piece of knowledge to achieve herd immunity. While people of all ages, occupations, and communities are at risk of getting infected with SARS-CoV-2, the health care workers (HCWs) are possibly at the highest risk. Most seroprevalence surveys with HCWs conducted worldwide have been limited to Europe, North America, and East Asia. We aimed to understand how the seroprevalence of SARS-CoV-2 IgG antibodies varied across these geographic regions among HCWs based on the available evidences.

METHODS

By searching through PubMed, ScienceDirect, and Google Scholar databases, eligible studies published from January 1, 2020 to January 15, 2021 were included for the systematic review and meta-analysis. The random-effects model was used to estimate the pooled proportion of IgG seropositive HCWs. Publication bias was assessed by funnel plot and confirmed by Egger's test. Heterogeneity was quantified using I2 statistics. We performed sensitivity analyses based on sample size, diagnostic method and publication status. The study protocol was registered with PROSPERO (CRD42020219086).

FINDINGS

A total of 53 peer-reviewed articles were selected, including 173,353 HCWs (32.7% male) from the United States, ten European, and three East Asian countries. The overall seropositive prevalence rate of IgG antibodies was 8.6% in these regions (95% CI= 7.2-9.9%). Pooled seroprevalence of IgG antibodies was higher in studies conducted in the USA (12.4%, 95% CI= 7.8-17%) than in Europe (7.7%, 95% CI=6.3-9.2%) and East Asia (4.8%, 95% CI=2.9-6.7%). The subgroup study also estimated that male HCWs had 9.4% (95% CI= 7.2-11.6%) IgG seroconversion, and female HCWs had 7.8% (95% CI=5.9-9.7%). The study exhibits a high prevalence of IgG antibodies among HCWs under 40 years in the USA, conversely, it was high in older HCWs (≥40 years of age) in Europe and East Asia. In the months February-April 2020, the estimated pooled seroprevalence was 5.7% (4.0-7.4%) that increased to 8·2% (6.2-10%) in April-May and further to 9.9% (6.9-12.9%) in the May-September time-period.

INTERPRETATION

In the view of all evidence to date, a significant variation in the prevalence of SARS-CoV-2 antibodies in HCWs is observed in regions of Europe, the United States, and East Asia. The patterns of IgG antibodies by time, age, and gender suggest noticeable regional differences in transmission of the virus. Based on the insights driven from the analysis, priority is required for effective vaccination for older HCWs from Europe and East Asia. A considerable high seroprevalence of IgG among HCWs from the USA suggests a high rate of past infection that indicates the need to take adequate measures to prevent hospital spread. Moreover, the seroprevalence trend was not substantially changed after May 2020, suggesting a slow progression of long-term SARS-CoV-2 immunity. Routine testing of HCWs for SARS-CoV-2 should be considered even after the rollout of vaccination to identify the areas of increased transmission.

FUNDING

None.

Efficacy and Safety of Hydroxychloroquine vs Placebo for Pre-exposure SARS-CoV-2 Prophylaxis Among Health Care Workers: A Randomized Clinical Trial

IMPORTANCE

Health care workers (HCWs) caring for patients with coronavirus disease 2019 (COVID-19) are at risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, to our knowledge, there is no effective pharmacologic prophylaxis for individuals at risk.

OBJECTIVE

To evaluate the efficacy of hydroxychloroquine to prevent transmission of SARS-CoV-2 in hospital-based HCWs with exposure to patients with COVID-19 using a pre-exposure prophylaxis strategy.

DESIGN, SETTING, AND PARTICIPANTS

This randomized, double-blind, placebo-controlled clinical trial (the Prevention and Treatment of COVID-19 With Hydroxychloroquine Study) was conducted at 2 tertiary urban hospitals, with enrollment from April 9, 2020, to July 14, 2020; follow-up ended August 4, 2020. The trial randomized 132 full-time, hospital-based HCWs (physicians, nurses, certified nursing assistants, emergency technicians, and respiratory therapists), of whom 125 were initially asymptomatic and had negative results for SARS-CoV-2 by nasopharyngeal swab. The trial was terminated early for futility before reaching a planned enrollment of 200 participants.

INTERVENTIONS

Hydroxychloroquine, 600 mg, daily, or size-matched placebo taken orally for 8 weeks.

MAIN OUTCOMES AND MEASURES

The primary outcome was the incidence of SARS-CoV-2 infection as determined by a nasopharyngeal swab during the 8 weeks of treatment. Secondary outcomes included adverse effects, treatment discontinuation, presence of SARS-CoV-2 antibodies, frequency of QTc prolongation, and clinical outcomes for SARS-CoV-2-positive participants.

RESULTS

Of the 132 randomized participants (median age, 33 years [range, 20-66 years]; 91 women [69%]), 125 (94.7%) were evaluable for the primary outcome. There was no significant difference in infection rates in participants randomized to receive hydroxychloroquine compared with placebo (4 of 64 [6.3%] vs 4 of 61 [6.6%]; P > .99). Mild adverse events were more common in participants taking hydroxychloroquine compared with placebo (45% vs 26%; P = .04); rates of treatment discontinuation were similar in both arms (19% vs 16%; P = .81). The median change in QTc (baseline to 4-week evaluation) did not differ between arms (hydroxychloroquine: 4 milliseconds; 95% CI, -9 to 17; vs placebo: 3 milliseconds; 95% CI, -5 to 11; P = .98). Of the 8 participants with positive results for SARS-CoV-2 (6.4%), 6 developed viral symptoms; none required hospitalization, and all clinically recovered.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, although limited by early termination, there was no clinical benefit of hydroxychloroquine administered daily for 8 weeks as pre-exposure prophylaxis in hospital-based HCWs exposed to patients with COVID-19.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04329923.

COVID-19 risk in elective surgery during a second wave: a prospective cohort study

Background

The COVID‐19 pandemic has greatly affected access to elective surgery, largely because of concerns for patients and healthcare workers. A return to normal surgery workflow depends on the prevalence and transmission of coronavirus in elective surgical patients. The aim of this study was to determine the prevalence of active SARS‐coronavirus‐2 infection during a second wave among patients admitted to hospital for elective surgery in Victoria.

Methods

Prospective cohort study across eight hospitals in Victoria during July–August 2020 was conducted enrolling adults and children admitted to hospital for elective surgery or interventional procedure requiring general anaesthesia. Study outcomes included a positive polymerase chain reaction (PCR) test for SARS‐CoV‐2 in the preoperative period (primary outcome), and for those with a negative test preoperatively, the incidence of a positive PCR test for SARS‐CoV‐2 in the post‐operative period.

Results

We enrolled 4965 elective adult and paediatric surgical patients from 15 July to 31 August 2020. Four patients screened negative on questionnaire but had a positive PCR test for coronavirus, resulting in a Bayesian estimated prevalence of 0.12% (95% probability interval 0–0.26%). There were no reports of healthcare worker infections linked to elective surgery during and up to 2 weeks after the study period.

Conclusion

The prevalence of SARS‐CoV‐2 in asymptomatic elective surgical patients during a second wave was approximately 1 in 833. Given the very low likelihood of coronavirus transmission, and with existing current hospital capacity, recommencement of elective surgery should be considered. A coronavirus screening checklist should be mandated for surgical patients.

Segurança e educação durante a COVID-19: prevalência, fatores associados e planos de reabertura da Faculdade de Enfermagem

Resumo Objetivo analisar a prevalência e os fatores associados à triagem da COVID-19 e propor as estratégias necessárias para a reabertura das Escolas de Enfermagem universitárias para as aulas presenciais. Métodos um estudo transversal foi projetado a partir da linha de base de uma pesquisa longitudinal baseada na Internet de uma Escola Brasileira de Enfermagem. Com o resultado ordinal (classificação operacional COVID-19), a análise de dados foi conduzida usando um modelo de regressão multinomial. Resultados um total de 498 participantes foi incluído na análise e revelou 67,27% de casos suspeitos e 11,65% de casos confirmados de COVID-19. O uso de máscaras, o transporte público e fazer parte da linha de frente dos trabalhadores da saúde foram estatisticamente associados a um histórico positivo para a COVID-19. Conclusão os planos de reabertura de Escolas de Enfermagem devem integrar o uso de equipamentos de proteção pessoal, o transporte público e a triagem da COVID-19 na educação.

Antibody response and therapy in COVID-19 patients: what can be learned for vaccine development?

The newly emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people and caused tremendous morbidity and mortality worldwide. Effective treatment for coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 infection is lacking, and different therapeutic strategies are under testing. Host humoral and cellular immunity to SARS-CoV-2 infection is a critical determinant for patients’ outcomes. SARS-CoV-2 infection results in seroconversion and production of anti-SARS-CoV-2 antibodies. The antibodies may suppress viral replication through neutralization but might also participate in COVID-19 pathogenesis through a process termed antibody-dependent enhancement. Rapid progress has been made in the research of antibody response and therapy in COVID-19 patients, including characterization of the clinical features of antibody responses in different populations infected by SARS-CoV-2, treatment of COVID-19 patients with convalescent plasma and intravenous immunoglobin products, isolation and characterization of a large panel of monoclonal neutralizing antibodies and early clinical testing, as well as clinical results from several COVID-19 vaccine candidates. In this review, we summarize the recent progress and discuss the implications of these findings in vaccine development.