High seroprevalence of SARS-CoV-2 antibodies among people living in precarious situations in Ile de France

ABSTRACT

BackgroundA nationwide lockdown was implemented in France on 17 March 2020 to control the COVID-19 pandemic. People living in precarious conditions were relocated by the authorities to emergency shelters, hotels and large venues. Medecins sans Frontieres (MSF) then intervened to provide medical care in several of these locations in Paris and in Seine-Saint-Denis, one of its suburbs, between March and June 2020. A seroprevalence survey was conducted to assess the level of exposure to COVID-19 among the population living in the sites. To our knowledge, this is the first assessment of the impact of the pandemic on populations living in insecure conditions in Europe. MethodsWe conducted a cross-sectional seroprevalence study in the food distribution sites, emergency shelters and workers residences supported by MSF in Paris and Seine-Saint-Denis, to determine the extent of COVID-19 exposure as determined by SARS-CoV2 antibody seropositivity. The detection of SARS-COV2 antibodies in serum was performed at the Institut Pasteur of Paris using two LuLISA (Luciferase-Linked Immunosorbent Assay) assays and a Pseudo Neutralization Test. A questionnaire covering sociodemographic characteristics, living conditions, adherence to sanitary recommendations and symptom manifestations was also completed. We describe here the seroprevalence site by site and identify the risk factors for seropositivity using a multivariable logistic regression model with site random effects. We also investigated associations between seropositivity and symptoms eventually reported. FindingsOverall, 426/818 individuals tested positive in the 14 sites investigated. Seroprevalence varied significantly with the type of site (chi2 p<0.001). It was highest at 88.7% (95%CI 81.8-93.2) among individuals living in workers residences, followed by 50.5% (95%CI 46.3-54.7) in emergency shelters and 27.8 % (95%CI 20.8-35.7) among individuals recruited from the food distribution sites. Seroprevalence also varied significantly between sites of the same type. Among other risk factors, the odds for seropositivity were higher among individuals living in crowded sites (medium adj. OR 2.7, 95%CI 1.5-5.1, p=0.001; high adj. OR 3.4, 95%CI 1.7-6.9, p<0.001) compared with individuals from low crowding sites and among those who reported transit accommodation in a gymnasium before the lockdown (adj. OR 3.1, 95%CI 1.2-8.1, p=0.023). More than two-thirds of the seropositive individuals (68.3%; 95%CI 64.2-72.2) did not report any symptoms during the recall period. InterpretationThe results demonstrate rather high exposure to SARS-COV-2 with important variations between study sites. Living in crowded conditions was identified as the most important explanatory factor for differences in levels of exposure. This study describes the key factors which determine the risk of exposure and illustrates the importance of identifying populations at high risk of exposure in order to orient and adapt prevention and control strategies to their specific needs.