Serological testing reveals the hidden COVID-19 burden among healthcare workers experiencing a SARS-CoV-2 nosocomial outbreak.

We describe the results of testing healthcare workers from a tertiary care hospital in Japan, which had experienced a COVID-19 outbreak during the first peak of the pandemic, for SARS-CoV-2 specific antibody seroconversion. Using two chemiluminescent immunoassays and a confirmatory surrogate virus neutralization test, serological testing unveiled that a surprising 42.2% (27/64) of overlooked COVID-19 diagnoses had occurred when case detection had relied solely on SARS-CoV-2 nucleic acid amplification testing. This undetected portion of the COVID-19 iceberg beneath the surface may potentially have led to silent transmissions and triggered the spread. A questionnaire-based risk assessment was further indicative of exposures to specific aerosol-generating procedures, i.e. non-invasive ventilation, having had conveyed the highest transmission risks and served as the origin of outbreak. Our observations are supportive of a multi-tiered testing approach, including the use of serological diagnostics, in order to accomplish exhaustive case detection along the whole COVID-19 spectrum.

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Risk of COVID-19 Infection in Healthcare Workers Exposed During Use of Non-invasive Ventilation in a Tertiary Care Hospital in OmanRisk of COVID-19 Infection in Healthcare Workers Exposed During Use of Non-invasive Ventilation in a Tertiary Care Hospital in Oman

Oman Medical Journal ◽

10.5001/omj.2021.110 ◽

2021 ◽

Vol 36 (2) ◽

pp. e236-e236

Author(s):

Adil Al Lawati ◽

Faryal Khamis ◽

Samiha Al Habsi ◽

Khazina Al Dalhami

Keyword(s):

High Risk ◽

Healthcare Workers ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Significant Risk ◽

High Risk Population ◽

Care Hospital ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

Objectives: Healthcare workers (HCWs), especially those working on the front line, are considered to be at high risk of nosocomial acquisition of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). Little is known about the effectiveness of the recommended protective methods as few reports have described spread of the disease in hospital settings among this high-risk population. We describe the hospital-based transmission of SARS-CoV-2 related to non-invasive ventilation (NIV) in one of the main tertiary care hospitals in Oman. Methods: All exposed patients and HCWs from Royal Hospital were screened, quarantined, and underwent telephone interviews to stratify their risk factors, clinical symptoms, and exposure risk assessment. Results: A total of 46 HCWs and patients tested positive for SARS-CoV-2 after exposure to an index case who received 48 hours of NIV before diagnosing COVID-19 infection. Over half of the exposed (56.5%; n = 26) were nurses, 26.1% (n = 12) were patients, and 15.2% (n = 7) were doctors. None of the HCWs required hospitalization. Sore throat, fever, and myalgia were the most common symptoms. Conclusions: NIV poses a significant risk for SARS-CoV-2 transmission within hospital settings if appropriate infection control measures are not taken.

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