ABSTRACT
Introduction. This study analyses how healthcare workers (HCWs) perceived risks, protection and preventive measures during the COVID-19 pandemic in relation to medically approved risks and organisational measures. The aim is to explore blind spots of pandemic protection and make mental health needs of HCWs visible. Methods. We have chosen an optimal-case scenario of a high-income country with a well-resourced hospital sector and low HCW infection rate at the organisational level to explore governance gaps in HCW protection. A German multi-method hospital study at Hannover Medical School served as empirical case; document analysis, expert information and survey data (n=1163) were collected as part of a clinical study into SARS-CoV-2 serology testing during the second wave of the pandemic (November 2020-February 2021). Selected survey items included perceptions of risks, protection and preventive measures. Descriptive statistical analysis and regression were undertaken for gender, profession and COVID-19 patient care. Results. The results reveal a low risk of 1% medically approved infections among participants, but a much higher mean personal risk estimate of 15%. The majority (68.4%) expressed some to very strong fear of acquiring infection at the workplace. Individual protective behaviour and compliance with protective workplace measures were estimated as very high. Yet only about half of the respondents felt strongly protected by the employer; 12% even perceived no or little protection. Gender and contact with COVID-19 patients had no significant effect on the estimations of infection risks and protective workplace behaviour, but nursing was correlated with higher levels of personal risk estimations and fear of infection. Conclusions. A strong mismatch between low medically approved risk and personal risk perceptions of HCWs brings stressors and threats into view, that may be preventable through better information and risk communication and through investment in mental health and inclusion in pandemic preparedness plans.
Subject(s)
COVID-19 , Oculocerebrorenal SyndromeABSTRACT
Vaccine-induced neutralizing antibodies are key in combating the COVID-19 pandemic. However, delays of boost immunization due to limited availability of vaccines may leave individuals vulnerable to infection and disease for prolonged periods. The emergence of SARS-CoV-2 variants of concern (VOC), B.1.1.7 (United Kingdom), B.1.351 (South Africa) and P.1 (Brazil), may reinforce this issue with the latter two being able to evade control by antibodies. We assessed humoral and T cell responses against SARS-CoV-2 WT and VOC and endemic human coronaviruses (hCoV) that were induced after single and double vaccination with BNT162b2. Despite readily detectable IgG against the receptor-binding domain (RBD) of the SARS-CoV-2 S protein at day 14 after a single vaccination, inhibition of SARS-CoV-2 S-driven host cell entry was weak and particularly low for the B.1.351 variant. Frequencies of SARS-CoV-2 specific T cells were low in many vaccinees after application of a single dose and influenced by immunity against endemic hCoV. The second vaccination significantly boosted T cell frequencies reactive for WT, B.1.1.7 and B.1.351 variants. These results call into question whether neutralizing antibodies significantly contribute to protection against COVID-19 upon single vaccination and suggest that cellular immunity is central for the early defenses against COVID-19.
Subject(s)
Severe Acute Respiratory Syndrome , COVID-19ABSTRACT
BackgroundDuring the current pandemic, healthcare professionals (HCP) have been at the frontline of the crisis. Serological screening may help in identifying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevalence. However, given the rapidly evolving situation in spring 2020, many questions regarding coronavirus disease 2019 (COVID-19) infection risk and utility of serological testing remained unanswered. To address these questions, we initiated the COVID-19 Contact (CoCo) study at Hannover Medical School, a large university hospital in Northern Germany and affiliated care providers. MethodsThe CoCo study is an ongoing, prospective, longitudinal, observational study in HCP and individuals with potential contact to SARS-CoV-2. It monitors anti-SARS-CoV-2 immunoglobulin serum levels and collects information on symptoms of respiratory infection, work and home environment, and self-perceived SARS-CoV-2 infection risk. Inclusion criteria are (1) working as HCP in clinical care at our university centre, affiliated hospitals or private practices, (2) written informed consent and (3) age >18 years. Exclusion criteria are (1) refusal to give informed consent and (2) contraindication to venepuncture. Study participants are asked to provide weekly to six-monthly samples (7.5 ml serum and 7.5 ml EDTA blood) and fill out a questionnaire. Since March 2020, around 1250 HCP have been included in the study. At each study visit, sera are screened for anti-SARS-CoV-2 spike protein 1 (S1) immunoglobulin G (IgG) by enzyme-linked immunosorbent assay (ELISA). Positive or borderline positive samples are re-assessed with an alternative serological test. Individual results for each study participant are made available online via a dedicated study website. This study also aims to compare different serological testing assays, as well as explore further humoral and cellular immune markers. Study protocols are continually adapted to the rapidly evolving situation of the current pandemic. DiscussionThis ongoing prospective study will aim to answer central questions on the prevalence and kinetics of anti-SARS-CoV-2-humoral immune responses and the validity of serological testing of HCP in a region with high healthcare standard and comparatively low COVID-19 prevalence. As such, our results are highly relevant to other regions and may support HCP around the world in managing this unprecedented situation. Trial registrationGerman Clinical Trial Registry, DRKS00021152. Registered 4th April 2020 -retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021152 Protocol summary O_TBL View this table: org.highwire.dtl.DTLVardef@1066beborg.highwire.dtl.DTLVardef@9734b4org.highwire.dtl.DTLVardef@1052a3dorg.highwire.dtl.DTLVardef@183b87org.highwire.dtl.DTLVardef@ec4318_HPS_FORMAT_FIGEXP M_TBL C_TBL
Subject(s)
COVID-19 , Coronavirus Infections , Respiratory Tract InfectionsABSTRACT
BackgroundSerology testing is explored for epidemiological research and to inform individuals after suspected infection. During the COVID-19 pandemic, frontline healthcare professionals (HCP) may be at particular risk for infection. No longitudinal data on functional seroconversion in HCP in regions with low COVID-19 prevalence and low pre-test probability exist. MethodsIn a large German university hospital, we performed weekly questionnaire assessments and anti-SARS-CoV-2 IgG measurements with various commercial tests, a novel surrogate virus neutralization test, and a neutralization assay using live SARS-CoV-2. ResultsFrom baseline to week six, n=1,080 screening measurements for anti-SARS CoV-2 (S1) IgG from n=217 frontline HCP (65% female) were performed. Overall, 75.6% of HCP reported at least one symptom of respiratory infection. Self-perceived infection probability declined over time (from mean 20.1% at baseline to 12{middle dot}4 % in week six, p<0.001). In sera of convalescent PCR-confirmed COVID-19 patients, we measured high anti-SARS-CoV-2 IgG levels, obtained highly concordant results from ELISAs using e.g. the S1 spike protein domain and the nucleocapsid protein (NCP) as targets, and confirmed antiviral neutralization. However, in HCP the cumulative incidence for anti-SARS-CoV-2 (S1) IgG was 1.86% for positive and 0.93% for equivocal positive results over the six week study period. Except for one HCP, none of the eight initial positive results were confirmed by alternative serology tests or showed in vitro neutralization against live SARS CoV-2. The only true seroconversion occurred without symptoms and mounted strong functional humoral immunity. Thus, the confirmed cumulative incidence for neutralizing anti-SARS-CoV-2 IgG was 0.47%. ConclusionWhen assessing anti-SARS-CoV-2 immune status in individuals with low pre-test probability, we suggest confirming positive results from single measurements by alternative serology tests or functional assays. Our data highlight the need for a methodical serology screening approach in regions with low SARS-CoV-2 infection rates.
Subject(s)
COVID-19ABSTRACT
Background: The COVID-19 pandemic has disrupted healthcare systems worldwide. Besides the direct impact of the virus on morbidity and mortality of patients, the effect of lockdown strategies on health and healthcare utilization become more and more apparent. Little is known on the effect of the pandemic on pediatric healthcare utilization. We examined the impact of the pandemic on pediatric emergency healthcare. Methods: : We conducted a monocentric, retrospective analysis of n=5.424 pediatric emergency visits between January 1 st and April 19 th of 2019 and 2020, and compared healthcare utilization in the month post lockdown 2020 to the same period in 2019. Results: : In the four weeks after lockdown in Germany began, we observed a massive drop of 63.8% in pediatric emergency healthcare utilization (mean daily visits 26.8 ±SEM 1.5 in 2019 vs. 9.7 ±SEM 1 in 2020, p<0.005). This drop in cases occurred for both communicable and non-communicable diseases. A larger proportion of patients under one year old (daily mean of 16.6% ±SEM 1.4 in 2019 vs 23.1% ±SEM 1.7, p<0.01 in 2020) and of cases requiring hospitalisation (mean of 13.9% ±SEM 1.6 in 2019 vs. 26.6% ±SEM 3.3 in 2020, p<0.001) occurred during the pandemic. During the analysed time periods, few intensive care admissions and no fatalities occurred. Conclusion: Our data illustrate a significant decrease in pediatric emergency room visits during the COVID-19 pandemic. Public outreach is needed to encourage parents to seek medical attention for pediatric emergencies in spite of the pandemic.
Subject(s)
COVID-19 , EmergenciesABSTRACT
Uncertain rates of asymptomatic infections have raised concerns about potentially high rates of thus far undiagnosed SARS-CoV-2 infections. Serological testing for SARS-CoV-2 specific IgG can be helpful in identification of asymptomatic infections. We report baseline results of the CVOID-19 Contact (CoCo) Study, which follows 217 frontline healthcare workers at a university hospital and performs weekly SARS-CoV-2 specific serology (IgA/IgG). The majority of participants had direct contact to patients with infectious respiratory diseases. Study participants estimated their personal likelihood of having had a SARS-CoV-2 infection with a mean of 20.9% (range 0 to 90%). In contrast, anti-SARS-CoV-2-IgG prevalence was in the range of 1-2% among health care workers. The CoCo Study is not fully representative for other hospitals and the sensitivity of anti-SARS-CoV-2 serology in low prevalence conditions may require further improvement. Taken together, low rates of SARS-CoV-2 specific IgG in healthcare workers in Northern Germany are in sharp contrast to the high personal risk perception. Regular anti-SARS-CoV-2 IgG testing of health-care workers may aid in monitoring the pandemic, assessing the quality of immune responses, directing resources for protective measures, and assuring CVID-19 care in the long run.