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Review 3: "Seroprevalence of SARS-COV-2 Antibodies in Scottish Healthcare Workers"

This study reports a greater seroprevalence for antibodies among healthcare workers compared to the general population. Reviewers mentioned concerns over selection of the general population, response bias, and adjusting for potential cross-reactivity with other coronaviruses.

Published onDec 17, 2020
Review 3: "Seroprevalence of SARS-COV-2 Antibodies in Scottish Healthcare Workers"
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key-enterThis Pub is a Review of
Seroprevalence of SARS-COV-2 Antibodies in Scottish Healthcare Workers
Description

Abstract Introduction Healthcare workers are believed to be at increased risk of SARS-CoV-2 infection. The extent of that increased risk compared to the general population and the groups most at risk have not been extensively studied.Methods A prospective observational study of health and social care workers in NHS Tayside (Scotland, UK) from May to September 2020. The Siemens SARS-CoV-2 total antibody assay was used to establish seroprevalence in this cohort. Patients provided clinical information including demographics and workplace information. Controls, matched for age and sex to the general Tayside population, were studied for comparison.Results A total of 2062 health and social care workers were recruited for this study. The participants were predominantly female (81.7%) and 95.2% were white. 299 healthcare workers had a positive antibody test (14.5%). 11 out of 231 control sera tested positive (4.8%). Healthcare workers therefore had an increased likelihood of a positive test (odds ratio 3.4 95% CI 1.85-6.16, p<0.0001). Dentists, healthcare assistants and porters were the job roles most likely to test positive. Those working in front-line roles with COVID-19 patients were more likely to test positive (17.4% vs. 13.4%, p=0.02). 97.1% of patients who had previously tested positive for SARS-CoV-2 by RT-PCR had positive antibodies, compared to 11.8% of individuals with a symptomatic illness who had tested negative. Anosmia was the symptom most associated with the presence of detectable antibodies.Conclusion In this study, healthcare workers were three times more likely to test positive for SARS-CoV-2 than the general population. The seroprevalence data in different populations identified in this study will be useful to protect healthcare staff during future waves of the pandemic.

RR:C19 Evidence Scale rating by reviewer:

  • Potentially informative. The main claims made are not strongly justified by the methods and data, but may yield some insight. The results and conclusions of the study may resemble those from the hypothetical ideal study, but there is substantial room for doubt. Decision-makers should consider this evidence only with a thorough understanding of its weaknesses, alongside other evidence and theory. Decision-makers should not consider this actionable, unless the weaknesses are clearly understood and there is other theory and evidence to further support it.

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Review:

Introduction should be expanded since there are a great number of studies and meta-analyses that estimate seroprevalence of SARS-COV-2 antibodies among healthcare workers, e.g. https://doi.org/10.1016/j.jhin.2020.11.008. Authors make comments about personal protective equipment and infection prevention and control in the Introduction section but these issues are not included in their study.

Methods section suffers from several flaws. This is definitely not a prospective observational study but a cross-sectional study with just one measurement for the participants. The response rate is not mentioned. Authors refer to two control groups in the Results section, but these groups are not clear in the Methods section. Also, random selection of blood samples taken at NHS Tayside General Practice Surgeries should be explained in detail. Statistical analysis is poor since the authors should perform multivariable logistic regression analysis with seroprevalence of SARS-COV-2 antibodies as the dependent variable to eliminate confounding. Afterwards, they should adjust their Discussion section according to the new findings.

The 95% confidence interval for seroprevalence of SARS-COV-2 antibodies should be presented as well as adjusted seroprevalence for the sensitivity and the specificity of antibodies test.

Figures should be removed and tables with multivariable logistic regression analysis with seroprevalence of SARS-COV-2 antibodies as the dependent variable should be added.

Recommendation: Manuscript needs major revision. Claims are not strongly supported, but may yield some insight by the data and methods used. Decision-makers should consider the claims in this study not actionable (except to prompt further research), unless the weaknesses are clearly understood and there is other theory and evidence to further support them based on the methods and data.

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