Prevalence of SARS-CoV-2 Infection Among Health Care Workers in a Tertiary Community Hospital | Health Care Workforce | JAMA Internal Medicine | JAMA Network
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Figure.  Health Care Workers Who Tested Positive for SARS-CoV-2 Antibodies by Job Title and Department
Health Care Workers Who Tested Positive for SARS-CoV-2 Antibodies by Job Title and Department

Percentage of employees who tested positive for antibodies based on job title (A) and department (B). The dotted line indicates the general population on Long Island. A total of 1699 employees were surveyed, including 322 in ancillary services, 100 in environmental health, 1043 nurses, 79 physicians, and 155 technologists. Of the 1699 employees, 88 worked in the emergency room (ER), 489 on the hospital floor, 321 in the intensive care unit (ICU), 400 in operational services (ie, employees who rotate through all areas of the hospital), 243 in procedural services (eg, operating room, cardiac procedures, diagnostic radiology procedures, endoscopy), and 158 in other services.

Table.  Breakdown of the Reverse Transcriptase–Polymerase Chain Reaction (RT-PCR) and Antibody Results in Employees
Breakdown of the Reverse Transcriptase–Polymerase Chain Reaction (RT-PCR) and Antibody Results in Employees
1.
Amid ongoing COVID-19 pandemic, Governor Cuomo announces State Health Department will partner with Attorney General James to investigate nursing home violations. April 23, 2020. Accessed July 30, 2020. https://www.governor.ny.gov/news/amid-ongoing-covid-19-pandemic-governor-cuomo-announces-state-health-department-will-partner
2.
CDC COVID-19 Response Team.  Characteristics of health care personnel with COVID-19—United States, February 12-April 9, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(15):477-481.PubMedGoogle ScholarCrossref
3.
Infection control guidance for healthcare professionals about coronavirus (COVID-19). Centers for Disease Control and Prevention. Updated June 3, 2020. Accessed May 1, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html
4.
Lai  J, Ma  S, Wang  Y,  et al.  Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019.   JAMA Netw Open. 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976PubMedGoogle Scholar
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    Concerning cross-reactivity of SARS-CoV-2 antibody testing in prevalence investigation
    Yang Xu, MD | Shanghai University of Medicine and Health Sciences
    Serological testing is a key investigative tool in the COVID-19 prevalence investigation and can identify an infected family or school cluster, especially patients with mild illness. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological testing may help diagnose suspected patients with negative polymerase chain reaction (PCR) results and those with mild or asymptomatic infections (1). This will allow a more accurate determination of the percentage of infected people.

    Jeremias et al. (2) reported SARS-CoV-2 IgG positive rates were 9.8% in healthcare workers and 16.7% in the local population, respectively. However, the authors used an Abbott Architect SARS-CoV-2 IgG CMIA
    test kit, which is designed to detect IgG antibodies to the nucleocapsid protein of SARS-CoV-2 (3).

    SARS-CoV-2 and SARS-CoV patients have cross-reactivity of spike receptor-binding domain (RBD) and nucleocapsid (N) protein. Lv et al. (4) reported plasma samples of patients with COVID-19 that showed significant cross-reactivity with SARS-CoV N protein. The author also reported plasma samples from patients with severe acute respiratory syndrome (SARS) that could significantly cross-react with SARS-CoV-2 spike RBD and N protein (4).

    Grifoni et al. (5) investigated donors who were not exposed to COVID-19 and found SARS-CoV-2 and seasonal “common cold” human coronaviruses patients have cross-reactivity of SARS-CoV-2 T cell epitopes. Approximately 50% SARS-CoV-2 N protein-specific CD4+ T cell responses in COVID-19 cases were detected among non-contact donors. It was determined that non-contact donors have cross-reactivity to SARS-CoV-2 N protein. If the patient shows the N protein cross-reaction and an anti-spike or nucleocapsid protein detection kit is used, it may affect the evaluation of the prevalence survey (1,5).

    Therefore, the cross-reactivity of SARS-CoV-2 antibody testing may affect prevalence survey. The authors should address the limitation of the test kit that is designed to detect IgG antibodies to the nucleocapsid protein of SARS-CoV-2 in the study.

    References

    1. Long Q, Liu B, Deng H, et al. Antibody responses to SARS-CoV-2 in patients with COVID-19. Nat. Med. 2020; 26: 845-848.
    2. Jeremias A, Nguyen J, Levine J, et al. Prevalence of SARS-CoV-2 infection among health care workers in a tertiary community hospital. JAMA Intern Med. Published online Aug 11, 2020. doi: 10.1001/jamainternmed.2020.4214.
    3. EUA authorized serology test performance. https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/eua-authorized-serology-test-performance
    4. Lv H, Wu NC, Tsang OT, et al. Cross-reactive antibody response between SARSCoV-2 and SARS-CoV infections. Cell Rep. 2020; 31:107725. doi: 10.1016/j.celrep.2020.107725.
    5. Grifoni, A., Weiskopf, D., Ramirez, S.I., et al. Targets of T cell responses to SARS-CoV-2 coronavirus in humans with COVID-19 disease and unexposed individuals. Cell 2020; 181:1489–1501.
    CONFLICT OF INTEREST: None Reported
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    Research Letter
    August 11, 2020

    Prevalence of SARS-CoV-2 Infection Among Health Care Workers in a Tertiary Community Hospital

    Author Affiliations
    • 1Department of Medicine, St Francis Hospital, The Heart Center, Roslyn, New York
    • 2Department of Biostatistics, St Francis Hospital, The Heart Center, Roslyn, New York
    • 3Department of Laboratory Medicine, St Francis Hospital, The Heart Center, Roslyn, New York
    JAMA Intern Med. Published online August 11, 2020. doi:10.1001/jamainternmed.2020.4214

    New York City and its surrounding metro area have emerged as an epicenter of the coronavirus disease 2019 (COVID-19) outbreak worldwide. A recent population survey1 for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies among those in New York state shows a prevalence of 21.2% in New York City and 16.7% in Long Island. Across the US, up to 11% of reported COVID-19 cases were found to be in health care professionals,2 but the true prevalence of COVID-19 among health care workers is unknown. The aim of the present study is to establish the rate of COVID-19 among health care workers by widespread screening for SARS-CoV-2 exposure.

    Methods

    Employees were tested with a reverse transcriptase–polymerase chain reaction (RT-PCR) test and an antibody test from March 1 to April 30, 2020, at a large tertiary community hospital in Roslyn, New York. The health system began offering antibody testing (Anti-SARS-CoV-2 ELISA [IgG] [EUROIMMUN US]; SARS-CoV2-IgG [Abbott]) on April 16, 2020, and encouraged all employees to be tested. Antibody testing was performed in workers who were asymptomatic or were previously symptomatic with no symptoms for at least 14 days. Hospital employees who had symptoms of COVID-19 were offered the RT-PCR test (cobas SARS-CoV-2 [Roche] and Xpert Xpress SARS-CoV-2 [Cepheid]). All testing was on a voluntary basis. Personal protective equipment (PPE) policy was based on US Centers for Disease Control and Prevention guidelines3 and was dependent on risk of exposure. All employees caring for patients with COVID-19 were required to wear an N95 mask, isolation gown, and gloves. Health care workers involved with procedures that could generate aerosolized virus dispersal, such as mechanical intubation, required additional eye protection. Both χ2 and t tests were used to generate P values and 95% CIs to analyze categorical variables. All statistical analyses were performed using SAS version 9.4 (SAS Institute). The Institutional Review Board at St Francis Hospital approved the study and waived the need for informed consent due to its retrospective nature and anonymization of all employee data.

    Results

    Among 3046 employees, 1699 (56%) underwent antibody testing, 617 (20%) underwent RT-PCR testing, and 359 (12%) underwent both. The average (SD) age among all employees was 42.8 (13.8) years and 2137 (70%) were women (Table). When comparing employees who elected to undergo either form of testing vs those who did not, there were no meaningful differences with respect to age, job title, or work area.

    There were 167 employees (9.8%) who tested positive for antibodies. There was no significant difference in antibody positive rates across job titles or work areas (Figure). When comparing the prevalence of antibodies among hospital employees with the rate reported by the State of New York for the general public on Long Island, hospital employees had a significantly lower positive rate (9.9% vs 16.7%, P < .001).

    Employees with positive antibody test results were similar in age (41.5 [SD, 13.5] vs 43.4 [SD, 13.7] years, P = .09) and sex (women 9.4% vs men 11.1%, P = .31). There was no significant difference between race as a whole (Table). There was no significant difference in infection rates among those working in high vs low exposure areas (10.9% vs 10.9%, P = .99).

    Discussion

    The findings of the present study indicate that the rate of SARS-CoV-2 infection among health care workers is lower than what has been reported for the general public in the surrounding region. Given that health care workers in hospitals are exposed to a much higher density of the virus, this is strong evidence that current PPE practices are protective, easing health care workers’ concern and psychological distress.4

    Limitations

    Limitations of this study are that it is a single-center analysis from a large community hospital that has the capability to adequately supply PPE to all health care workers. The present results may therefore not be applicable to all health care settings. Testing for COVID-19 was offered on a voluntary basis, with most employees complying. While no differences were observed between those tested and those not tested, a potential selection bias cannot be completely excluded.

    Conclusions

    In conclusion, PPE, when available and properly used, confers protection and lower infection rates of COVID-19 among health care workers when compared with reported infection rates in the general public.

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    Article Information

    Corresponding Author: Allen Jeremias, MD, MSc, Division of Cardiology, Department of Medicine, St Francis Hospital, The Heart Center, 100 Port Washington Blvd, #105, Roslyn, NY 11576 (allen.jeremias@chsli.org).

    Published Online: August 11, 2020. doi:10.1001/jamainternmed.2020.4214

    Author Contributions: Drs Nguyen and Pollack had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Jeremias, Levine, Thakore.

    Acquisition, analysis, or interpretation of data: Jeremias, Nguyen, Pollack, Engellenner, Thakore, Lucore.

    Drafting of the manuscript: Jeremias, Nguyen.

    Critical revision of the manuscript for important intellectual content: Levine, Pollack, Engellenner, Thakore, Lucore.

    Statistical analysis: Nguyen, Pollack.

    Administrative, technical, or material support: Nguyen, Levine, Engellenner, Thakore, Lucore.

    Supervision: Jeremias.

    Conflict of Interest Disclosures: None reported.

    Additional Contributions: Guy Aristide, MD (St Francis Hospital, The Heart Center); J. Jane Cao, MD, MPH (St Francis Hospital, The Heart Center); Gary Gecelter, MD; Ronald J. Gulotta, MD (St Francis Hospital, The Heart Center); Maya A. Jeremias (St Francis Hospital, The Heart Center); Stefan M. Muehlbauer, MD, PhD; Patrick O’Shaughnessy, MD (St Francis Hospital, The Heart Center); Newell Robinson, MD; Richard Shlofmitz, MD (St Francis Hospital, The Heart Center). None of the contributors was compensated and none reported any conflicts or disclosures.

    References
    1.
    Amid ongoing COVID-19 pandemic, Governor Cuomo announces State Health Department will partner with Attorney General James to investigate nursing home violations. April 23, 2020. Accessed July 30, 2020. https://www.governor.ny.gov/news/amid-ongoing-covid-19-pandemic-governor-cuomo-announces-state-health-department-will-partner
    2.
    CDC COVID-19 Response Team.  Characteristics of health care personnel with COVID-19—United States, February 12-April 9, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(15):477-481.PubMedGoogle ScholarCrossref
    3.
    Infection control guidance for healthcare professionals about coronavirus (COVID-19). Centers for Disease Control and Prevention. Updated June 3, 2020. Accessed May 1, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html
    4.
    Lai  J, Ma  S, Wang  Y,  et al.  Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019.   JAMA Netw Open. 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976PubMedGoogle Scholar
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