Seroepidemiology among Employees of New York City Health and Hospitals during the First Wave of the SARS-CoV-2 Epidemic

ObjectiveEstimate the seroprevalence of SARS-CoV-2 antibodies among New York City Health + Hospitals healthcare workers, and identify demographic and occupational factors associated with SARS-CoV-2 antibodies among healthcare workers. MethodsThis was an observational, cross-sectional study using data from SARS-CoV-2 serological tests accompanied by a demographic and occupational survey administered to healthcare workers. Participants were employed by New York City Health + Hospitals (NYC H+H) and either completed serologic testing at NYC H+H between April 30 and June 30, 2020, or completed SARS-CoV-2 antibody testing outside of NYC H+H and were able to self-report results. ResultsSeven hundred twenty-seven survey respondents were included in analysis. Participants had a mean age of 46 years (SD= 12.19) and 543 (75%) were women. Two hundred fourteen (29%) participants tested positive or reported testing positive for the presence of SARS-CoV-2 antibodies (IgG+). Characteristics associated with positive SARS-CoV-2 serostatus were Black race (25% IgG+ vs. 15% IgG-, p=0.001), having someone in the household with COVID symptoms (49% IgG+ vs. 21% IgG-, p<0.001), or having a confirmed COVID-19 case in the household (25% IgG+ vs 5% IgG-, p<0.001). Characteristics associated with negative SARS-CoV-2 serostatus included working on a COVID patient floor (27% IgG+ vs. 36% IgG-, p=0.02), working in the ICU (20% IgG+ vs. 28% IgG-, p=0.03), or having close contact with a patient with COVID-19 (51% IgG+ vs. 62% IgG-, p=0.03). ConclusionsResults underscore the significance of community factors and inequities might have on SARS-CoV-2 exposure for healthcare workers. What is already known about this subject?Healthcare workers are at risk of occupational transmission of SARS-CoV-2, and the risk of infection varies by demographic characteristics and work location. What are the new findings?Healthcare worker race and household contacts were significantly associated with SARS-CoV-2 seropositivity, while working on a COVID patient floor or ICU was associated with seronegativity. How might this impact on policy or clinical practice in the foreseeable future?Results underscore the significance of community factors and inequities on healthcare worker exposure to SARS-CoV-2, and the need to address these inequities at the community level where healthcare workers live.

DRUL for School: Opening Pre-K with safe, simple, sensitive saliva testing for SARS-CoV-2

To address the need for simple, safe, sensitive, and scalable SARS-CoV-2 tests, we validated and implemented a PCR test that uses a saliva collection kit use at home. Individuals self-collected 300 {micro}l saliva in vials containing Darnell Rockefeller University Laboratory (DRUL) buffer and extracted RNA was assayed by RT-PCR (the DRUL saliva assay). The limit of detection was confirmed to be 1 viral copy/{micro}l in 20 of 20 replicate extractions. Viral RNA was stable in DRUL buffer at room temperature up to seven days after sample collection, and safety studies demonstrated that DRUL buffer immediately inactivated virus at concentrations up to 2.75x106 PFU/ml. Results from SARS-CoV-2 positive nasopharyngeal (NP) swab samples collected in viral transport media and assayed with a standard FDA Emergency Use Authorization (EUA) test were highly correlated with samples placed in DRUL buffer. Direct comparison of results from 162 individuals tested by FDA EUA oropharyngeal (OP) or NP swabs with co-collected saliva samples identified four otherwise unidentified positive cases in DRUL buffer. Over six months, we collected 3,724 samples from individuals ranging from 3 months to 92 years of age. This included collecting weekly samples over 10 weeks from teachers, children, and parents from a pre-school program, which allowed its safe reopening while at-risk pods were quarantined. In sum, we validated a simple, sensitive, stable, and safe PCR-based test using a self-collected saliva sample as a valuable tool for clinical diagnosis and screening at workplaces and schools.

Factors associated with COVID-19 vaccine receipt at two integrated healthcare systems in New York City: A Cross sectional study of healthcare workers

ObjectivesTo examine factors associated with COVID-19 vaccine receipt among healthcare workers, including healthcare worker job type, race, and gender, as well as the role of vaccine confidence in decisions to vaccinate, and to better understand specific concerns related to COVID-19 vaccination among healthcare workers. DesignCross-sectional anonymous survey among front-line, support service, and administrative healthcare workers. SettingTwo large integrated healthcare systems (one private and one public) in New York City during the initial rollout of the COVID-19 vaccine among healthcare workers. Participants1,933 healthcare workers, including nurses, physicians, allied health professionals, environmental services staff, researchers, and administrative staff. Main Outcome MeasuresThe primary outcome was COVID-19 vaccine receipt during the initial rollout of the vaccine among healthcare workers. ResultsAmong 1,933 healthcare workers who had been offered the vaccine, 81% had received the vaccine at the time of the survey. Receipt was lower among Black (58%) compared with White (91%) healthcare workers; and lower among Hispanic (69%) compared with non-Hispanic (84%) healthcare workers. Among healthcare workers with concerns about COVID-19 vaccine safety, 65% received the vaccine. Among healthcare workers who agreed with the statement that the vaccine is important to protect family members, 86% were vaccinated. Of those who disagreed, 25% received the vaccine. Across all participants, 27% expressed concern about being experimented on with the COVID-19 vaccine. In a multivariable analysis, concern about being experimented on with the COVID-19 vaccine, concerns about COVID-19 vaccine safety, lack of influenza vaccine receipt, disagreeing that COVID-19 vaccination is important to protect family members, and Black race were independently associated with COVID-19 vaccine non-receipt. Over 70% of all healthcare workers responded that they had been approached for vaccine advice multiple times by family, community members, and patients. ConclusionsOur data demonstrated high overall receipt among healthcare workers. Even among healthcare workers with concerns about COVID-19 vaccine safety, side effects, or being experimented on, over 50% received the vaccine. Attitudes around the importance of COVID-19 vaccination to protect others played a large role in healthcare workers decisions to vaccinate. We observed striking inequities in COVID-19 vaccine receipt, particularly affecting Black and Hispanic workers. Further research is urgently needed in developing strategies with healthcare workers to address issues related to vaccine equity and uptake in the context of systemic racism and barriers to care. This is particularly important given the influence healthcare workers have in vaccine decision-making conversations in their communities. SUMMARY BOXES What is already known?O_LIHigh uptake of effective COVID-19 vaccines among healthcare workers is critical to pandemic response. C_LIO_LIIn studies of potential COVID-19 vaccine acceptance prior to COVID-19 vaccine availability, people who identified as Black were less likely to indicate they would accept the vaccine. C_LIO_LIUnderstanding reasons why some healthcare workers chose not to get the COVID-19 vaccine will help us develop interventions to improve COVID-19 vaccine confidence among healthcare workers and in their communities. C_LI What this study addsO_LIWe demonstrate high receipt of COVID-19 vaccines in the initial rollout among healthcare workers. C_LIO_LIAttitudes around the importance of COVID-19 vaccination to protect others played a large role in healthcare workers decisions to vaccinate. C_LIO_LIWe observed substantially lower rates of receipt among Black and Hispanic healthcare workers, independent of differences in vaccine-related beliefs. A quarter of healthcare workers expressed concerns about being experimented on. These results suggest systemic racism may be a critical barrier to equitable vaccination. C_LIO_LIOur results highlight that healthcare workers of all types, including those with non-patient-facing roles, play an important role as sources of COVID-19 vaccine information in their communities. C_LI

Universal screening for SARS-CoV-2 infection among pregnant women at Elmhurst Hospital Center, Queens, New York

BackgroundUniversal screening for SARS-CoV-2 infection on Labor and Delivery (L&D) units is a critical strategy to manage patient and health worker safety, especially in a vulnerable high-prevalence community. We describe the results of a SARS-CoV-2 universal screening program at the L&D Unit at Elmhurst Hospital in Queens, NY, a 545-bed public hospital serving a diverse, largely immigrant and low-income patient population and an epicenter of the global pandemic. Methods and findingsWe conducted a retrospective cross-sectional study. All pregnant women admitted to the L&D Unit of Elmhurst Hospital from March 29, 2020 to April 22, 2020 were included for analysis. The primary outcomes of the study were: (1) SARS-CoV-2 positivity among universally screened pregnant women, stratified by demographic characteristics, maternal comorbidities, and delivery outcomes; and (2) Symptomatic or asymptomatic presentation at the time of testing among SARS-CoV-2 positive women. A total of 126 obstetric patients were screened for SARS-CoV-2 between March 29 and April 22. Of these, 37% were positive. Of the women who tested positive, 72% were asymptomatic at the time of testing. Patients who tested positive for SARS-CoV-2 were more likely to be of Hispanic ethnicity (unadjusted difference 24.4 percentage points, CI 7.9, 41.0) and report their primary language as Spanish (unadjusted difference 32.9 percentage points, CI 15.8, 49.9) than patients who tested negative. ConclusionsIn this retrospective cross-sectional study of data from a universal SARS-Cov-2 screening program implemented in the L&D unit of a safety-net hospital in Queens, New York, we found over one-third of pregnant women testing positive, the majority of those asymptomatic. The rationale for universal screening at the L&D Unit at Elmhurst Hospital was to ensure safety of patients and staff during an acute surge in SARS-Cov-2 infections through appropriate identification and isolation of pregnant women with positive test results. Women were roomed by their SARS-CoV-2 status given increasing space limitations. In addition, postpartum counseling was tailored to infection status. We quickly established discharge counseling and follow-up protocols tailored to their specific social needs. The experience at Elmhurst Hospital is instructive for other L&D units serving vulnerable populations and for pandemic preparedness.