SARS-CoV-2 Antibodies in the Public Hospital Staff: The Second Report of a Seroprevalence Cohort Study from Iran

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Abstract

Background: SARS-CoV-2 is a novel virus that caused the recent global pandemic. Health care workers (HCWs), especially hospital staff, are at a higher risk of infection by this virus than the general population. In this study, anti-SARS-CoV-2 IgG antibodies were assessed in hospital workers. Methods: This prospective seroconversion-based cohort study assessed chronic immunity against covid-19 in the staff of two hospitals, the main referral hospital and a general hospital in Shiraz, south of Iran. A valid and reliable checklist was filled out for each available staff member willing to participate in this study through a face-to-face interview. Furthermore, the titer of anti-covid-19 IgG was measured by ELISA twice; in July 2020 after the second wave of COVID-19 and in February 2021 after the third wave in IRAN. Results: One hundred forty (65%) of the 214 members who participated in both stages of this consideration were from the COVID-19 referral healing center, and 74 (35%) were from the common clinic. Twelve (5.6%) of staff members had anti-SARS-CoV-2 IgG antibodies, including 10 (7.1%) from the referral healing center and 2 (2.7%) from the common healing center (P = 0.23). In the second measurement (second overview), 79 (36.9%) of members had IgG antibodies; 58 (41.4%) from the primary hospital and 21 (28.3%) from the second healing center (P = 0.039). Cruel of the IgG titer within the first study and the referral clinic was 0.8 ± 0.3 compared to 0.15 ± 0.42 within the common clinic (P = 0.001). These figures were 3.05 ± 4.58 and 1.74 ± 3.53 in both clinics and within the second overview separately (P = 0.003). IgG levels were significantly higher in the second overview compared to the first (P < 0.0001). Conclusions: During the third wave of COVID-19, a significant proportion of hospital staff developed COVID-19 IgG, especially in the referral hospitals for COVID-19. As a result of their higher and chronic exposure to COVID-19 patients than the general hospital staff, the titer of IgG in the referral hospital staff was also higher. However, the seroconversion rate between the two waves was 1.8 times in the general hospital staff compared to the referral hospital, possibly due to less conservative precautions against covid-19 among them. Even after receiving the anti-covid-19 vaccination, it is important to monitor the immunity of hospital staff to covid-19 and to adhere strictly to standard precautions.

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A Novel Coronavirus from Patients with Pneumonia in China, 2019

Na Zhu, Dingyu Zhang, Wenling Wang … (2020)

Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)

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SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients

Lirong Zou, Feng Ruan, Mingxing Huang … (2020)

To the Editor: The 2019 novel coronavirus (SARS-CoV-2) epidemic, which was first reported in December 2019 in Wuhan, China, and has been declared a public health emergency of international concern by the World Health Organization, may progress to a pandemic associated with substantial morbidity and mortality. SARS-CoV-2 is genetically related to SARS-CoV, which caused a global epidemic with 8096 confirmed cases in more than 25 countries in 2002–2003. 1 The epidemic of SARS-CoV was successfully contained through public health interventions, including case detection and isolation. Transmission of SARS-CoV occurred mainly after days of illness 2 and was associated with modest viral loads in the respiratory tract early in the illness, with viral loads peaking approximately 10 days after symptom onset. 3 We monitored SARS-CoV-2 viral loads in upper respiratory specimens obtained from 18 patients (9 men and 9 women; median age, 59 years; range, 26 to 76) in Zhuhai, Guangdong, China, including 4 patients with secondary infections (1 of whom never had symptoms) within two family clusters (Table S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org). The patient who never had symptoms was a close contact of a patient with a known case and was therefore monitored. A total of 72 nasal swabs (sampled from the mid-turbinate and nasopharynx) (Figure 1A) and 72 throat swabs (Figure 1B) were analyzed, with 1 to 9 sequential samples obtained from each patient. Polyester flock swabs were used for all the patients. From January 7 through January 26, 2020, a total of 14 patients who had recently returned from Wuhan and had fever (≥37.3°C) received a diagnosis of Covid-19 (the illness caused by SARS-CoV-2) by means of reverse-transcriptase–polymerase-chain-reaction assay with primers and probes targeting the N and Orf1b genes of SARS-CoV-2; the assay was developed by the Chinese Center for Disease Control and Prevention. Samples were tested at the Guangdong Provincial Center for Disease Control and Prevention. Thirteen of 14 patients with imported cases had evidence of pneumonia on computed tomography (CT). None of them had visited the Huanan Seafood Wholesale Market in Wuhan within 14 days before symptom onset. Patients E, I, and P required admission to intensive care units, whereas the others had mild-to-moderate illness. Secondary infections were detected in close contacts of Patients E, I, and P. Patient E worked in Wuhan and visited his wife (Patient L), mother (Patient D), and a friend (Patient Z) in Zhuhai on January 17. Symptoms developed in Patients L and D on January 20 and January 22, respectively, with viral RNA detected in their nasal and throat swabs soon after symptom onset. Patient Z reported no clinical symptoms, but his nasal swabs (cycle threshold [Ct] values, 22 to 28) and throat swabs (Ct values, 30 to 32) tested positive on days 7, 10, and 11 after contact. A CT scan of Patient Z that was obtained on February 6 was unremarkable. Patients I and P lived in Wuhan and visited their daughter (Patient H) in Zhuhai on January 11 when their symptoms first developed. Fever developed in Patient H on January 17, with viral RNA detected in nasal and throat swabs on day 1 after symptom onset. We analyzed the viral load in nasal and throat swabs obtained from the 17 symptomatic patients in relation to day of onset of any symptoms (Figure 1C). Higher viral loads (inversely related to Ct value) were detected soon after symptom onset, with higher viral loads detected in the nose than in the throat. Our analysis suggests that the viral nucleic acid shedding pattern of patients infected with SARS-CoV-2 resembles that of patients with influenza 4 and appears different from that seen in patients infected with SARS-CoV. 3 The viral load that was detected in the asymptomatic patient was similar to that in the symptomatic patients, which suggests the transmission potential of asymptomatic or minimally symptomatic patients. These findings are in concordance with reports that transmission may occur early in the course of infection 5 and suggest that case detection and isolation may require strategies different from those required for the control of SARS-CoV. How SARS-CoV-2 viral load correlates with culturable virus needs to be determined. Identification of patients with few or no symptoms and with modest levels of detectable viral RNA in the oropharynx for at least 5 days suggests that we need better data to determine transmission dynamics and inform our screening practices.

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Presumed Asymptomatic Carrier Transmission of COVID-19

Yan Bai, Lingsheng Yao, Tao Wei … (2020)

This study describes possible transmission of novel coronavirus disease 2019 (COVID-19) from an asymptomatic Wuhan resident to 5 family members in Anyang, a Chinese city in the neighboring province of Hubei.