key: cord-0838901-spd9cmlp authors: Yun, Brian J.; Baugh, Joshua J.; Dutta, Sayon; Brown, David F.M.; Temin, Elizabeth S.; Turbett, Sarah E.; Shenoy, Erica S.; Biddinger, Paul D.; Dighe, Anand S.; Kays, Kyle; Parry, Blair A.; McKaig, Brenna; Beakes, Caroline; Margolin, Justin; Russell, Nicole; Lodenstein, Carl; McEvoy, Dustin S.; Filbin, Michael R. title: COVID-19 Seroprevalence in Emergency Department Healthcare Professionals Study (COV-ED): A Cross-sectional study date: 2022-04-22 journal: J Emerg Nurs DOI: 10.1016/j.jen.2022.04.003 sha: 9327b1ab170401acc1f11417eca6e1da73a4f87d doc_id: 838901 cord_uid: spd9cmlp OBJECTIVE: Emergency department (ED) healthcare professionals (HCP) are at the frontline of evaluation and management of patients with acute, and often undifferentiated, illness. During the initial phase of the SARS-CoV-2 outbreak, there were concerns that ED HCPs may have been at increased risk of exposure to SARS-CoV-2 due to difficulty in early identification and isolation of patients. This study assessed the seroprevalence of SARS-CoV-2 antibodies among ED HCPs including attending physicians, residents, advanced practice providers, and nurses without prior confirmed history of COVID-19 infection at a quaternary academic medical center. METHODS: This study was a prospective, cross-sectional study. An ED healthcare professional was deemed eligible if they had worked at least four shifts in the adult ED from April 1, 2020, through May 31, 2020, were asymptomatic on the day of blood draw, and were not known to have had prior documented COVID-19 infection. The study period was December 17, 2020, to January 27, 2021. Eligible participants completed a questionnaire and had a blood sample drawn. Samples were run on the Roche Cobas Elecsys Anti-SARS-CoV-2 antibody assay. RESULTS: A total of 103 healthcare professionals (16 attending physicians, 4 emergency residents, 16 advanced practice professionals, and 67 full-time emergency nurses) completed the survey and had their blood drawn. While 17 healthcare professionals reported suspecting they had a prior undiagnosed COVID-19 infection, only three (1 attending physician, 1 advanced practice provider, 1 nurse) of the 103 (2.9%, exact 95% Confidence Interval [0.6%, 8.3%]) were seropositive for SARS-CoV-2 antibodies. CONCLUSION: At this quaternary academic medical center among those who volunteered to take an antibody test, there was a low seroprevalence of SARS-CoV-2 antibodies among ED clinicians who were asymptomatic at the time of blood draw and not known to have had prior COVID-19 infection. Despite many unknowns early in the pandemic, the rate of asymptomatic infections appears to be low. Practice" and abstract. 10 Query authors as needed for word limits in abstract. 11 • Emergency department (ED) healthcare professionals (HCP) are often the first point of 14 hospital contact for patients with an acute illness. There were concerns that ED HCPs 15 may have been at increased risk of exposure to SARS-CoV-2. 16 • At a single institution, there was a seroprevalence of 2.9% for SARS-CoV-2 antibodies 17 among ED HCPs who had never been formally diagnosed with • Adherence to infection control protocols, including implementation of universal masking, 19 and use of appropriate PPE for patients with suspected or confirmed COVID-19 or 20 confirmed exposures effectively mitigates risk of transmission in healthcare settings. Emergency department (ED) healthcare professionals (HCP) are at the frontline of 25 evaluation and management of patients with acute, and often undifferentiated, illness. During the 26 initial phase of the SARS-CoV-2 outbreak, there were concerns that ED HCPs may have been at 27 increased risk of exposure to SARS-CoV-2 due to difficulty in early identification and isolation 28 of patients. This study assessed the seroprevalence of SARS-CoV-2 antibodies among ED HCPs 29 J o u r n a l P r e -p r o o f including attending physicians, residents, advanced practice providers, and nurses without prior 30 confirmed history of COVID-19 infection at a quaternary academic medical center. This study was a prospective, cross-sectional study. An ED healthcare professional was 33 deemed eligible if they had worked at least four shifts in the adult ED from April 1, 2020, 34 through May 31, 2020, were asymptomatic on the day of blood draw, and were not known to 35 have had prior documented COVID-19 infection. The study period was December 17, 2020, to 36 January 27, 2021. Eligible participants completed a questionnaire and had a blood sample drawn. Samples were run on the Roche Cobas Elecsys Anti-SARS-CoV-2 antibody assay. A total of 103 healthcare professionals (16 attending physicians, 4 emergency residents, At this quaternary academic medical center among those who volunteered to take an 47 antibody test, there was a low seroprevalence of SARS-CoV-2 antibodies among ED clinicians 48 who were asymptomatic at the time of blood draw and not known to have had prior infection. Despite many unknowns early in the pandemic, the rate of asymptomatic infections 50 appears to be low. and not occupational risks. 6, 7 In 2020 in a multistate hospital network study involving 13 65 academic medical centers, the authors found that seroprevalence among HCPs correlated with 66 community COVID-19 incidence. 6 Also, in 2020 in a hospital-wide screening study at a Tertiary 67 Center in Belgium, researchers found that having a household contact with COVID-19 was 68 associated with seropositivity when compared to having no household exposure. They did not In addition, using the electronic medical record, we identified each subject's number of 104 encounters with ED patients with confirmed COVID-19 (diagnosed prior to ED arrival or 105 diagnosed based on NAT performed in the ED) from April 1, 2020, to the day before the blood 106 draw date. The participant must have either assigned themselves to the patient's treatment team 107 or written a note in the patient's chart for the encounter to be included in the analysis. CoV-2 antibodies. One was an attending physician, one was an advanced practice provider, and 133 one was an emergency nurse. All three had subsequent negative SARS-CoV-2 NAT results. Additional characteristics of the seronegative and seropositive participants are summarized in 135 Table 1 . When asked if coworkers wore the recommended PPE when caring for patients with 137 confirmed or suspected COVID-19, 47% of respondents strongly agreed, 48% agreed, and 3% 138 disagreed with the statement. When asked if the study participant wore the recommended PPE 139 when caring for patients with confirmed or suspected COVID-19, 68% strongly agreed, 33% 140 agreed, and 1% disagreed with the statement. The primary limitation of the study is selection bias, and the results should be interpreted 170 with caution. It is possible those who did not respond were more or less likely to have contracted 171 COVID-19 than our sample population. It is plausible that those who enrolled in our study would 172 be more likely to believe that they had previously contracted COVID-19, making it unlikely that 173 the true seroprevalence is significantly higher than our results. A second limitation is the time 174 elapsed between the first pandemic surge and the study period. Some subjects may have been 175 SARS-CoV-2 seropositive and over time converted to seronegative. A third limitation is that we 176 were precluded from doing an analysis of potential risk factors for having antibodies because we 177 did not collect demographic information and there was a low number of subjects with a positive 178 antibody test. 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