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Federal Register / Vol. 86, No. 116 / Monday, June 21, 2021 / Rules and Regulations
conducted looked at a type of antibody known as Immunoglobulin G IgG.
Seroprevalence studies provide a more complete picture of how many individuals in a population may have been infected because many individuals who were infected were not tested for current infections for reasons such as lack of symptoms and lack of available testing. Indeed, many individuals who were asymptomatic may be unaware that they were exposed to SARSCoV
2 or had COVID19 CDC, July 6, 2020.
The studies described below were conducted before vaccination began, and it is therefore unlikely that the studies are detecting antibodies produced as a result of vaccination.
Venugopal et al., 2020 conducted a cross-sectional study of healthcare employees across all hospital services including physicians, nurses, ancillary services, and others who worked at a level one trauma center in the South Bronx, NY between March 1 and May 1, 2020. The period of analysis included the first few weeks of March, when New York City experienced a surge of infections that resulted in strained resources and supplies such as PPE.
This hospital was so highly impacted that it was considered the epicenter of the epicenter. Participants were tested for IgG antibodies. They were also tested for SARSCoV2. Of the 500 out of 659
healthcare employees who completed serology testing, 137 27% were positive for SARSCoV2 IgG
antibodies. Seroprevalence was similar across the different types of healthcare employees 25% to 28%. The study authors indicated that seroprevalence in healthcare employees was higher than in the community, and that seroprevalence likely reflected healthcare and community exposures.
Sims et al., November 5, 2020
conducted a prospective cohort serology study at Beaumont Health, which includes eight hospitals across the Detroit, MI metropolitan area. In April of 2020, during the peak of the pandemics first wave, Michigan had the third highest number of cases in the U.S. and most cases were in the Detroit metropolitan area. All 43,000 hospital employees were invited to participate and seroprevalence was analyzed in 20,614 of them between April 13 and May 28, 2020. A total of 1,818 8.8% of participants were seropositive.
However, when separated according to employees working at home n=1,868
versus working in their normal manner, employees working at home were significantly less likely to be seropositive 5.6% than those going into work 9.1%. The authors speculated that the seropositivity level
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for employees working at home was representative of the population sheltering at home and only leaving home when necessary. Participants involved with direct patient care had a higher seropositive rate 9.5% than those who were not 7%. Healthcare employees with frequent patient contact phlebotomy, respiratory therapy, and nursing had a significantly higher seropositive rate 11% than those with intermittent patient contact physicians or clinical roles such as physical therapists, radiology technicians, etc., who on average had a seropositive rate of 7.4%. The study authors speculated that the differences in these two groups may have been based on differences in both duration and proximity of exposure to patients. Another notable observation is that support personnel such as facilities/security and administrative support employees had seropositivity rates of approximately 7%
to 8%, which were similar to rates in physicians values estimated from Figure 2B. Participants reporting frequent contact with either 1 nonCOVID19 patients, or 2 physicians or nurses but not patients, had higher rates of seropositivity 7.6% than those reporting no significant contact with patients, physicians, or nurses but who handled patient samples 6.5%.
Moscola et al., September 1, 2020
reported the prevalence of SARSCoV
2 antibodies in healthcare employees from the Northwell Health System in the greater New York City area. The healthcare employees were offered free, voluntary testing at each of the systems 52 sites between April 20 and June 23, 2020. The analysis included 40,329 of the systems 70,812 employees and found that 5,523 13.7% were seropositive. The prevalence of SARS
CoV2 antibodies was similar to that found in randomly-tested adults in New York State at that time 14%. Analysis of seropositivity by job type reported the highest levels of seropositivity 20.9%
in service maintenance staff including housekeepers, groundskeepers, medical assistants, and 21 others, followed by 13.1% in nurses, 12.6% in administrative and clerical staff including non-clinical professionals such as employees in information technology, human resources, medical records, and billing; 11.6% in allied health professionals including clinical professionals such as physician assistants, physical therapists/
occupational therapists, social workers, mental health professionals, pharmacists, and laboratory technicians, and 8.7% in physicians.
Seropositivity rates were highest in
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employees from the emergency department and non-ICU hospital units approximately 17% each, followed by other non-specified areas 12.1%, and ICUs 9.9%.
Wilkins et al., 2021 conducted a cross-sectional study to examine seropositivity rates in 6,510 healthcare workers from a Chicago healthcare system consisting of hospitals, immediate care centers, and outpatient practices. Blood samples were collected through July 8, 2020. The study authors then compared the seropositivity rate of different occupational groups of workers, using administrators as the referent group to reflect exposure consistent with non-healthcare workers.
Overall seropositivity for all study participants was 4.8%. Before adjusting for demographics and self-reported outof-hospital exposure to COVID19, the study found that a number of healthcare occupations had a higher crude prevalence rate than the administrator group, including: 10.4% for support service healthcare workers; 10.1% for medical assistants; 9.3% for respiratory technicians; 7.6% for nurses; and 3.8%
for administrators. After adjustment for demographics and self-reported out-ofhospital exposure to COVID19, the only type of healthcare workers that continued to be significantly more likely to be seropositive than administrators were nurses, who were 1.9 times more likely to be seropositive. The study authors concluded that the higher workrelated risk in nurses likely occurred as a result of frequent and close contact with patients. The study also compared seropositivity rates for different occupational tasks and found that adjusted seropositivity rates were higher for workers participating in the care of COVID19 patients when compared with those who did not report participating in the care of COVID19
patients. Being exposed to patients receiving high-flow oxygen therapy and hemodialysis was significantly associated with 45% and 57% higher odds for seropositive status, respectively.
Comparison of Healthcare Worker Serology and the Surrounding Community Although some serology studies suggest that infections are more correlated to community transmission than job designation Jacob et al., March 10, 2021; Carter et al., May 2021, these studies do not undermine the robust evidence that healthcare employees with potential workplace exposure to patients with suspected or confirmed COVID19 are exposed to an elevated risk of contracting COVID19 compared
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