Quantification of Occupational and Community Risk Factors for SARS-CoV-2 Seropositivity Among Health Care Workers in a Large US Health Care System

• Type of Material: Article
• Authors: Julia M. Baker, Emory University; Kristin Nelson, Emory University; Elizabeth Overton, Emory Healthcare; Benjamin Lopman, Emory University; Timothy Lash, Emory University; Mark Photakis, Emory Healthcare; Jesse Jacob, Emory University; John Roback, Emory University; Scott Fridkin, Emory University; James Steinberg, Emory University
• Language: English
• Date: 2021-05-01
• Publisher: American College of Physicians
• Publication Version: Final Published Version
• Copyright Statement: © 2021 American College of Physicians. All Rights Reserved.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.7326/M20-7145
• Title of Journal or Parent Work: Annals of Internal Medicine
• Volume: 174
• Issue: 5
• Start Page: 649
• End Page: +
• Grant/Funding Information: By the Emory COVID-19 Response Collaborative (Drs. Nelson and Lopman);; National Science Foundation RAPID award (2032084) (Dr. Lopman);; Dr. Baker received support from grant T32AI074492 from the National Institute of Allergy and Infectious Diseases, National Institutes of Health.; the National Institute of General Medical Sciences, National Institutes of Health (R01GM124280-03S1).; Dr. Roback acknowledges generous funding from The Marcus Foundation, which supported development, implementation, and testing with the serology assay for anti-RBD antibodies.
• Keywords: General & Internal Medicine; Life Sciences & Biomedicine; Medicine, General & Internal; Science & Technology
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health; Health Sciences, Health Care Management

Abstract

Background: Identifying occupational risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among health care workers (HCWs) can improve HCW and patient safety. Objective: To quantify demographic, occupational, and community risk factors for SARS-CoV-2 seropositivity among HCWs in a large health care system. Design: A logistic regression model was fitted to data from a cross-sectional survey conducted in April to June 2020, linking risk factors for occupational and community exposure to coronavirus disease 2019 (COVID-19) with SARS-CoV-2 seropositivity. Setting: A large academic health care system in the Atlanta, Georgia, metropolitan area. Participants: Employees and medical staff members elected to participate in SARS-CoV-2 serology testing offered to all HCWs as part of a quality initiative and completed a survey on exposure to COVID-19 and use of personal protective equipment. Measurements: Demographic risk factors for COVID-19, residential ZIP code incidence of COVID-19, occupational exposure to HCWs or patients who tested positive on polymerase chain reaction test, and use of personal protective equipment as potential risk factors for infection. The outcome was SARS-CoV-2 seropositivity. Results: Adjusted SARS-CoV-2 seropositivity was estimated to be 3.8% (95% CI, 3.4%-4.3%) (positive, n = 582) among the 10 275 HCWs (35% of the Emory Healthcare workforce) who participated in the survey. Community contact with a person known or suspected to have COVID-19 (adjusted odds ratio [aOR], 1.9 [CI, 1.4 to 2.6]; 77 positive persons [10.3%]) and community COVID-19 incidence (aOR, 1.5 [CI, 1.0 to 2.2]) increased the odds of infection. Black individuals were at high risk (aOR, 2.1 [CI, 1.7 to 2.6]; 238 positive persons [8.3%]). Limitations: Participation rates were modest and key workplace exposures, including job and infection prevention practices, changed rapidly in the early phases of the pandemic. Conclusion: Demographic and community risk factors, including contact with a COVID-19–positive person and Black race, are more strongly associated with SARS-CoV-2 seropositivity among HCWs than is exposure in the workplace.