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      Demographic and occupational determinants of anti-SARS-CoV-2 IgG seropositivity in hospital staff

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          Abstract

          Background

          Although evidence suggests that demographic characteristics including minority ethnicity increase the risk of infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), it is unclear whether these characteristics, together with occupational factors, influence anti-SARS-CoV-2 IgG seroprevalence in hospital staff.

          Methods

          We conducted cross-sectional surveillance examining seroprevalence of anti-SARS-CoV-2 IgG amongst staff at University Hospitals of Leicester (UHL) NHS Trust. We quantified seroprevalence stratified by ethnicity, occupation and seniority of practitioner and used logistic regression to examine demographic and occupational factors associated with seropositivity.

          Results

          A total of 1148/10662 (10.8%) hospital staff members were seropositive. Compared to White staff (seroprevalence 9.1%), seroprevalence was higher in South Asian (12.3%) and Black (21.2%) staff. The occupations and department with the highest seroprevalence were nurses/healthcare assistants (13.7%) and the Emergency Department (ED)/Acute Medicine (17.5%), respectively. Seroprevalence decreased with seniority in medical/nursing practitioners. Minority ethnicity was associated with seropositivity on an adjusted analysis (South Asian: aOR 1.26; 95%CI: 1.07–1.49 and Black: 2.42; 1.90–3.09). Anaesthetics/ICU staff members were less likely to be seropositive than ED/Acute medicine staff (0.41; 0.27–0.61).

          Conclusions

          Ethnicity and occupational factors, including specialty and seniority, are associated with seropositivity for anti-SARS-Cov-2 IgG. These findings could be used to inform occupational risk assessments for front-line healthcare workers.

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          Most cited references20

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          Is Open Access

          OpenSAFELY: factors associated with COVID-19 death in 17 million patients

          COVID-19 has rapidly impacted on mortality worldwide. 1 There is unprecedented urgency to understand who is most at risk of severe outcomes, requiring new approaches for timely analysis of large datasets. Working on behalf of NHS England we created OpenSAFELY: a secure health analytics platform covering 40% of all patients in England, holding patient data within the existing data centre of a major primary care electronic health records vendor. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19 related deaths. COVID-19 related death was associated with: being male (hazard ratio 1.59, 95%CI 1.53-1.65); older age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared to people with white ethnicity, black and South Asian people were at higher risk even after adjustment for other factors (HR 1.48, 1.29-1.69 and 1.45, 1.32-1.58 respectively). We have quantified a range of clinical risk factors for COVID-19 related death in the largest cohort study conducted by any country to date. OpenSAFELY is rapidly adding further patients’ records; we will update and extend results regularly.
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            COVID-19 and African Americans

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              Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study

              Summary Background Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level. Methods 35 883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61 075 participants (75·1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximising either specificity (positive for both tests) or sensitivity (positive for either test). Findings Seroprevalence was 5·0% (95% CI 4·7–5·4) by the point-of-care test and 4·6% (4·3–5·0) by immunoassay, with a specificity–sensitivity range of 3·7% (3·3–4·0; both tests positive) to 6·2% (5·8–6·6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years ( 10%) and lower in coastal areas (<3%). Seroprevalence among 195 participants with positive PCR more than 14 days before the study visit ranged from 87·6% (81·1–92·1; both tests positive) to 91·8% (86·3–95·3; either test positive). In 7273 individuals with anosmia or at least three symptoms, seroprevalence ranged from 15·3% (13·8–16·8) to 19·3% (17·7–21·0). Around a third of seropositive participants were asymptomatic, ranging from 21·9% (19·1–24·9) to 35·8% (33·1–38·5). Only 19·5% (16·3–23·2) of symptomatic participants who were seropositive by both the point-of-care test and immunoassay reported a previous PCR test. Interpretation The majority of the Spanish population is seronegative to SARS-CoV-2 infection, even in hotspot areas. Most PCR-confirmed cases have detectable antibodies, but a substantial proportion of people with symptoms compatible with COVID-19 did not have a PCR test and at least a third of infections determined by serology were asymptomatic. These results emphasise the need for maintaining public health measures to avoid a new epidemic wave. Funding Spanish Ministry of Health, Institute of Health Carlos III, and Spanish National Health System.
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                Author and article information

                Contributors
                Journal
                J Public Health (Oxf)
                J Public Health (Oxf)
                pubmed
                Journal of Public Health (Oxford, England)
                Oxford University Press
                1741-3842
                1741-3850
                16 November 2020
                : fdaa199
                Affiliations
                Department of Respiratory Sciences , University of Leicester , Leicester LE1 7RH, UK
                Department of Infection and HIV Medicine , University Hospitals of Leicester NHS Trust , Leicester LE1 5WW, UK
                Department of Chemical Pathology and Metabolic Diseases , University Hospitals of Leicester NHS Trust , Leicester LE1 5WW, UK
                Department of Cardiovascular Sciences , University of Leicester , Leicester LE1 7RH, UK
                Department of Occupational Health , University Hospitals of Leicester NHS Trust , Leicester LE1 5WW, UK
                Department of Clinical Microbiology , University Hospitals of Leicester NHS Trust , Leicester LE1 5WW, UK
                Department of Immunology , University Hospitals of Leicester NHS Trust , Leicester LE1 5WW, UK
                Department of Haematology , University Hospitals of Leicester NHS Trust , Leicester LE1 5WW, UK
                Department of Chemical Pathology and Metabolic Diseases , University Hospitals of Leicester NHS Trust , Leicester LE1 5WW, UK
                Department of Cardiovascular Sciences , University of Leicester , Leicester LE1 7RH, UK
                Diabetes Research Centre , Leicester General Hospital, University of Leicester , Leicester LE5 4PW, UK
                Leicester Real World Evidence Unit , Diabetes Research Centre, Leicester General Hospital, University of Leicester , Leicester LE5 4PW, UK
                Department of Chemical Pathology and Metabolic Diseases , University Hospitals of Leicester NHS Trust , Leicester LE1 5WW, UK
                Department of Immunology , University Hospitals of Leicester NHS Trust , Leicester LE1 5WW, UK
                Department of Cardiovascular Sciences , University of Leicester , Leicester LE1 7RH, UK
                Department of Nephrology , Leicester General Hospital , Leicester LE5 4PW, UK
                Diabetes Research Centre , Leicester General Hospital, University of Leicester , Leicester LE5 4PW, UK
                NIHR Leicester Biomedical Research Centre , Leicester LE3 9QP, UK
                NIHR Applied Research Collaboration-East Midlands , Leicester LE5 4PW, UK
                Department of Respiratory Sciences , University of Leicester , Leicester LE1 7RH, UK
                Department of Infection and HIV Medicine , University Hospitals of Leicester NHS Trust , Leicester LE1 5WW, UK
                NIHR Leicester Biomedical Research Centre , Leicester LE3 9QP, UK
                NIHR Applied Research Collaboration-East Midlands , Leicester LE5 4PW, UK
                Author notes
                Address correspondence to Kamlesh Khunti, E-mail: kk22@ 123456le.ac.uk .

                Christopher A. Martin and Prashanth Patel are joint first authors and contributed equally to this work.

                Kamlesh Khunti and Manish Pareek are joint senior authors.

                Article
                fdaa199
                10.1093/pubmed/fdaa199
                7717317
                33200200
                74fa5ceb-3fc8-44ac-aec0-35b55b704b97
                © The Author(s) 2020. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

                History
                : 9 October 2020
                : 13 October 2020
                Page count
                Pages: 12
                Funding
                Funded by: National Institute of Health Research;
                Funded by: NIHR Development and Skills Enhancement;
                Award ID: NIHR301192
                Funded by: United Kingdom Research and Innovation/Medical Research Council;
                Award ID: MR/V027549/1
                Categories
                Original Article
                AcademicSubjects/MED00860
                Custom metadata
                PAP

                Public health
                covid-19,ethnicity,healthcare worker,sars-cov-2,seroprevalence
                Public health
                covid-19, ethnicity, healthcare worker, sars-cov-2, seroprevalence

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