ABSTRACT
Background International guidelines for testing potentially immunosuppressed cancer patients receiving non-surgical anticancer therapies for SARS-CoV-2 (COVID-19) are currently lacking. The value of routinely testing staff treating cancer patients is not known. Methods: Patient-facing oncology department staff at work during the COVID-19 pandemic consented to have a nasopharyngeal swab SARS-CoV-2 antigen test by polymerase chain reaction (PCR) and blood tests for SARS-CoV-2 antibody using a laboratory Luminex-based assay and a rapid point-of-care (POC) assay on 2 occasions 28 days apart in June and July 2020. Results 434 participants were recruited: nurses (58.3%), doctors (21.2%), radiographers (10.4%) and administrators (10.1%). 82% were female; median age 40-years (range 19-66). 26.3% reported prior symptoms suggestive of SARS-CoV-2 infection and 1.4% tested PCR-positive prior to June 2020. All were PCR-negative at both study day 1 and 28. 18.4% were SARS-CoV-2 sero-positive on day 1 by Luminex, of whom 42.5% also tested positive by POC. 47.5% of Luminex sero-positives had antibodies to both nucleocapsid (N) and surface (S) antigens. Nurses (21.3%) and doctors (17.4%) had higher prevalence trends of Luminex sero-positivity compared with administrators (13.6%) and radiographers (8.9%) (p=0.2). 38% of sero-positive participants reported previous symptoms suggestive of SARS-CoV-2 infection, a 1.9-fold higher odds than sero-negative participants (p=0.01). 400 participants re-tested on day 28: 13.3% were Luminex sero-positive of whom 92.5% were previously positive and 7.5% newly positive. Nurses (16.5%) had the highest seroprevalence trend amongst staff groups (p=0.07). 32.5% of day 1 sero-positives became sero-negative by day 28: the majority being previously reactive to the N-antigen only (p<0.0001). Conclusion The high prevalence of SARS-CoV-2 IgG sero-positivity in oncology nurses, and the high decline of positivity over 4 weeks supports regular antigen and antibody testing in this staff group for SARS-CoV-2 as part of routine patient care prior to availability of a vaccine.
Subject(s)
COVID-19 , NeoplasmsABSTRACT
Background: The global SARS-CoV-2 (COVID-19) pandemic has caused substantial worldwide mortality. At present, there is no data regarding oncologist-specific SARS-CoV-2 infection/immunity rates in the United Kingdom (UK) which might impact planning for the management of potentially immunosuppressed cancer patients. Here, we present the first results from the COVID-19 Serology in Oncology Staff (CSOS) study with the aim of informing non-surgical oncology management guidelines. Methods: Patient-facing staff working in an oncology department during the COVID-19 pandemic at a large district general hospital in the East of England were invited to participate. Samples were collected during the first week of June 2020: blood for SARS-COV-2 antibody testing using a rapid lateral flow point of care (POC) assay and a laboratory Luminex based assay, as well as a nasopharyngeal swab for SARS-CoV-2 PCR testing. Participant characteristics were also collected. Results: Seventy participants were recruited: nurses (45/70; 64.3%), doctors (15/70; 21.2%), and other patient-facing staff (10/70; 14.3%). The majority were female (61/70; 87.1%) with a mean age of 42 years (median 41; range 23-64 years). A minority were smokers (9/70; 10%) or had chronic underlying health conditions (16/70; 22.9%), the commonest being asthma. All participants were nasopharyngeal-swab PCR negative, although 4/70 (5.7%) had previously tested positive by NHS testing undertaken during the preceding months. 15/70 (21.4%) had positive SARS-CoV-2 antibodies using the Luminex test. Nurses had the highest incidence of positive antibodies (13/45; 28.9%), with a lower incidence in doctors (2/15; 13.3%) although this difference was not statistically significant (Fischer's exact test p=0.3). No receptionists had positive antibody tests. All four participants with a previously reported positive PCR test were antibody-positive. 9/15 (60%) of antibody-positive participants reported previous symptoms suggestive of SARS-CoV-2 infection: a 3.6-fold higher odds than antibody-negative participants, of whom 16/55 reported symptoms (p=0.03). The mean duration of symptoms was 11 days (median 11; range 1-35 days) and the mean time from resolution of reported previous symptoms to antibody testing was 48.4 days (median 46; range 1-123 days). Conclusion: This study establishes the SARS-CoV-2 exposure and carriage rate amongst patient-facing staff working in the oncology department of a large UK general hospital during the pandemic. These results may help inform UK national oncology patient management prior to the development of a viable vaccine or treatment.