SARS-CoV-2 antibodies more prevalent in African American, Hispanic HCWs
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Researchers reported that African American and Hispanic health care workers were more likely to test positive for SARS-CoV-2 antibodies than non-Hispanic white health care workers.
They also said that community factors have a major role in SARS-CoV-2 exposure among health care workers, highlighting the “importance of exposure sources beyond the workplace.”
Joseph E. Ebinger, MD, director of clinical analytics at Cedars-Sinai in Los Angeles, and colleagues based their findings on an analysis of data from a “diverse and unselected” group of 6,062 employees at the institution with direct and non-direct patient contact.
The researchers wrote that the overall seroprevalence among health care workers was 4.1% (95% CI, 3.1-5.7), “with higher estimates seen in younger compared with older employees and in Hispanics compared with non-Hispanics.”
Anosmia was the “most prominently associated” significant self-reported symptom (OR = 11.04), followed by fever (OR = 2.02) and myalgias (OR = 1.65), according to the researchers. After they adjusted for potential confounders, Ebinger and colleagues found that seroprevalence was “significantly associated” with contact with a COVID-19-diagnosed person in the household (OR = 5.73) or clinical work setting (OR = 1.76), as well as being of African American race (OR = 2.02) or Hispanic ethnicity (OR = 1.98).
In addition, multivariable-adjusted analyses of preexisting employee characteristics showed “main factors” linked to a greater likelihood of seropositive status were being African American (OR = 1.72; 95% CI, 1.03-2.89) or Hispanic (OR = 1.8; 95% CI, 1.31-2.46) compared with being non-Hispanic white.
“These disparities underscore the ongoing, urgent need for us to understand why certain demographics and communities remain at higher risk in the pandemic than others,” Kimia Sobhani, PhD, medical director of the clinical core laboratories, associate professor of pathology and laboratory medicine at Cedars-Sinai and study coauthor, said in a press release. “The reasons may well include structural and societal factors that we were unable to capture.”
The researchers linked older age (OR = 0.81 per age decade; 95% CI, 0.71-0.92) and a history of asthma (OR = 0.48; 95% CI, 0.28-0.83) to lower odds of seropositive status. Among all employees with seropositive status, hypertension was linked to higher antibody level (beta = 0.12 per 10-unit increment in the IgG index). A medical diagnosis of COVID-19 was also tied to a higher antibody level, the researchers wrote.
Also, multivariable-adjusted analyses of COVID-19-related exposures indicated that the characteristics linked to greater odds of seropositive status were having had a medical diagnosis of COVID-19 (OR = 7.78; 95% CI, 5.73-10.56) and a household member previously diagnosed with COVID-19 (OR = 9.42; 95% CI, 5.5-16.13), with a “similar trend” seen among only those who worked where patients with COVID-19 were treated (OR = 1.61; 95% CI, 1.18-2.18).
“Notably, domestic travel, dwelling type, number of people in the home and having children or common domestic pets were not associated with either seroprevalence or antibody level in the more completely adjusted multivariable models, which can account at least partially for the effects of unmeasured confounders that are not captured in the sparser models,” Ebinger and colleagues wrote.
Multivariable-adjusted analyses of COVID-19 response variables also showed that the “strongest self-reported symptom” tied to greater odds of seropositivity was anosmia (OR = 11.91; 95% CI, 7.77-18.24). Other symptoms tied to the presence of antibodies included myalgias, dry cough and loss of appetite.
“Notably, the symptoms associated with lower odds of seropositive status included sore throat and rhinorrhoea,” the researchers wrote. “Dyspnoea was significantly associated with higher IgG index levels in seropositive individuals (beta = 0.13).”
According to the researchers, a multivariable analysis consisting of all “significantly predictive preexisting characteristics from the prior models,” remained significantly associated with the presence of antibodies when analyzed together except for dry cough. Predictors that remained significantly associated with higher antibody levels included hypertension (beta = 0.1), previous COVID-19 diagnosis (beta = 0.1) working in a COVID-19 unit (beta = 0.06), nausea (= beta 0.06) and dyspnoea (beta = 0.08).
Ebinger and colleagues wrote that their findings align with other studies that indicate underrepresented populations, including Hispanics and African Americans, are “disproportionately affected” by COVID-19.
“Such differences exist even when all participants work not just in the same field, but for the same organization,” they continued. “Such a finding may indicate that community and non-work-related environmental factors are likely playing a significant role in the spread of COVID-19 among certain minority populations.”
Perspective
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There has been increasing evidence that Hispanics and African Americans have been disproportionately affected by COVID-19 infection. Serological tests such as IgG antibody testing for the SARS-CoV2 virus provide valuable information on the extent of exposure.
This large, diverse study from Ebinger and colleagues estimated the seroprevalence among health care workers having direct and indirect exposure to COVID-19 infection and identified factors associated with seropositivity. The researchers also studied the impact of demographics, exposure, and clinical characteristics on the serological status. They found that anosmia was the single strongest self-reported symptom associated with seropositivity and that the odds of seropositivity were higher in Hispanics and African Americans when compared with non-Hispanic whites. It is important to note that the odds were greater in these populations despite having the same work-related exposures. Therefore, non-work-related community and environmental factors contribute to this disproportionate spread of COVID-19 in these populations.
Discussions must happen between health care providers — primary care physicians, in particular — and their patients in identifying such environmental factors for SARS-CoV-2 and COVID-19. Physician-driven, community-wide education in curbing such non-work-related risk factors can help minimize racial disparities in COVID-19 infection rates. This study once again highlighted the importance of allocating more resources to these communities.
Findings similar to Ebinger and colleagues are likely to be generated if studies are conducted nationwide. However, the seroprevalence rate may vary in non-health care workers. Studies like theirs can also guide on reopening strategies and prioritizing higher-risk communities for vaccination. Future investigations are also necessary to estimate the seroprevalence among various professions among health care to further risk stratify the various kinds and lengths of exposures while caring for COVID-19 patients.
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