key: cord-0856499-zqkx4pv1 authors: Rebeiro, P. F.; Levinson, K. J.; Jolly, L.; Kassens, E.; Dizikes, G. J.; Steece, R. S.; Metzger, D. C.; Loos, M.; Buchheit, R.; Duncan, L. D.; Rolando, L. A.; Schmitz, J.; Hart, H. A.; Aronoff, D. M.; Team, Tennessee COVID-19 Serology Study title: Prevalence of IgG antibodies against the severe acute respiratory syndrome coronavirus-2 among healthcare workers in Tennessee during May and June, 2020 date: 2020-11-16 journal: medRxiv : the preprint server for health sciences DOI: 10.1101/2020.11.12.20230912 sha: 8f409be0785186c7eaf04894645246a6e3ed25b5 doc_id: 856499 cord_uid: zqkx4pv1 SARS-CoV-2 seroprevalence was low (<1%) in this large population of healthcare workers (HCWs) across the state of Tennessee (n=11,787) in May-June 2020. Among those with PCR results, 81.5% of PCR and antibody test results were concordant. SARS-CoV-2 seroprevalence was higher among HCWs working in high-community-transmission regions and among younger workers. These results may be seen as a baseline assessment of SARS-CoV-2 seroprevalence 44 among HCWs in the American South during a period of growth, but not yet saturation, of 45 infections among susceptible populations. In fact, this period of May-June 2020 was 46 marked by the extension of renewed and sustained community-wide transmission after 47 mandatory quarantine periods expired in several more populous regions of Tennessee. 48 Where community transmission remains low, HCWs may still be able to effectively 49 mitigate SARS-CoV-2 transmission, preserving resources for populations at high risk of 50 severe disease, and these sorts of data help highlight such strategies. 51 52 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted November 16, 2020. ; https://doi.org/10.1101/2020.11.12.20230912 doi: medRxiv preprint Keywords: SARS-CoV-2; COVID-19; healthcare workers; South; Tennessee 53 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted November 16, 2020. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Dates of sample collection and result reporting were used to assess trends in test 96 volume. Outcomes and differences in age at the date of sample collection and sex 97 assigned at birth (male or female) were also summarized by study enrollment site (as 98 available). 99 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Figure 1b) . 119 120 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. were IgG-and 34.5 (IQR: 26.6, 47.6) years among those who were IgG+ (Figure 2b) . 139 140 Among those ever PCR+, the proportion IgG+ was largely in agreement (percent 141 agreement=81.5%), though they were not completely concordant: 3 of 54 individuals 142 (5.6%) with test dates for both were IgG-even though they reported being PCR+ on ≥ 1 143 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted November 16, 2020. ; https://doi.org/10.1101/2020.11.12.20230912 doi: medRxiv preprint 8 test, and 7 of 54 (13.0%) were IgG+ though they had reported only having PCR-tests 144 (Supplemental Figure 1) . 145 146 In a broad sero-survey of nearly 12,000 HCWs in systems across Tennessee 148 during May-June 2020, the overall seropositivity for SARS-CoV-2 was low, approaching 149 1%. There was significant variation in seropositivity between healthcare systems, with 150 higher seropositivity among workers in larger urban centers in middle and eastern 151 Tennessee (Nashville and Knoxville). Seropositive persons were significantly younger 152 than seronegative individuals, though there were no sex differences. 153 The depth and breadth of the regional COVID-19 epidemic in the American 154 South had not yet made itself felt during the period of this particular sero-survey (8, 9) . 155 A smaller seroprevalence study (including 249 HCWs) from Nashville, conducted in 156 April, 2020, found a higher seroprevalence (7.6%) but focused on high-risk hospital 157 settings and detected any immunoglobulin isotype, including IgM, IgG, and IgA (10). 158 These results may be seen as a baseline assessment of SARS-CoV-2 159 seroprevalence among HCWs in the American South during a period of growth, but not cases per 100,000 population; by contrast, Knox (northeast Tennessee, home to Ballad 166 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted November 16, 2020. ; https://doi.org/10.1101/2020.11.12.20230912 doi: medRxiv preprint 9 Health and UTMC) and Hamilton (southeast Tennessee, home to Erlanger Health 167 System) counties saw only 1-5 new cases per 100,000 population in the same period. 168 As may be expected, these pronounced regional differences in community transmission 169 were reflected in differing levels of seropositivity among the corresponding HCW 170 There were limitations in this study. First, differences in sampling schemes 172 across health systems, and the voluntary participation of particular health systems, may 173 render this study population not representative of the entire population of HCWs in the 174 state of Tennessee, limiting generalizability. There also may have been outcome 175 misclassification present, as no test, has perfect diagnostic sensitivity and specificity (7). 176 Finally, this study did not have information on social network structures or other 177 characteristics to identify high-risk groups for SARS-CoV-2 exposure and transmission 178 among HCWs. 179 Seroprevalence patterns among HCWs, inherently at higher risk of exposure, 180 might change as local and regional epidemics evolve and might be impacted by disease 181 activity in the community, exposure mitigation efforts, personal protective equipment 182 supplies, and public health policies (quarantines, mask mandates, etc.). The nature of 183 SARS-CoV-2 transmission merits continued monitoring in this population in both the 184 long and short-term. 185 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted November 16, 2020. ; https://doi.org/10.1101/2020.11.12.20230912 doi: medRxiv preprint All authors report no other 187 conflicts beyond standard NIH grant funding (money paid to their institutions). This work 188 has not been presented at any meetings or in any other publications Tennessee COVID-19 Serology Study Team Assiatou Dialla (TN Dept of Health Clisby Hall 203 Shelby Lowrie 205 Stacy Prater (Erlanger Health System) All rights reserved. No reuse allowed without permission preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity The dynamic changes 215 of serum IgM and IgG against SARS-CoV-2 in patients with COVID-19 COVID-19 and Postinfection Immunity: 218 Limited Evidence, Many Remaining Questions Characteristics of Health Care Personnel with COVID-19-United 221 Clinical 226 evaluation of serological IgG antibody response on the Abbott Architect for 227 established SARS-CoV-2 infection SARS-CoV-2 IgG instructions for use Prevalence of SARS-CoV-2 Antibodies in Health Care Personnel in the New 231 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.The copyright holder for this this version posted November 16, 2020. All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.The copyright holder for this this version posted November 16, 2020. ; https://doi.org/10.1101/2020.11.12.20230912 doi: medRxiv preprint a.b. b.