Title

Analysis of accumulated SARS-CoV-2 seroconversion in North Carolina: The COVID-19 Community Research Partnership

Authors

John C. Williamson, Department of Internal Medicine, Section on Infectious Diseases, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America.
Thomas F. Wierzba, Department of Internal Medicine, Section on Infectious Diseases, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America.
Michele Santacatterina, Department of Biostatistics and Bioinformatics, Biostatistics Center, George Washington University, Rockville, Maryland, United States of America.
Iqra Munawar, Department of Internal Medicine, Section on Infectious Diseases, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America.
Austin L. Seals, Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America.
Christine Ann Pittman Ballard, Department of Internal Medicine, Section on Infectious Diseases, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America.
Martha Alexander-Miller, Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America.
Michael S. Runyon, Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, United States of America.
Lewis H. McCurdy, Department of Internal Medicine, Division of Infectious Diseases, Atrium Health, Charlotte, North Carolina, United States of America.
Michael A. Gibbs, Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, United States of America.
Amina Ahmed, Department of Pediatrics, Atrium Health, Charlotte, North Carolina, United States of America.
William H. Lagarde, Department of Pediatrics, WakeMed Health and Hospitals, Raleigh, North Carolina, United States of America.
Patrick D. Maguire, Department of Radiation Oncology, New Hanover Regional Medical Center, Wilmington, North Carolina, United States of America.
Robin King-Thiele, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, United States of America.
Terri Hamrick, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, United States of America.
Abdalla Ihmeidan, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, United States of America.
Shakira Henderson, Center for Research and Grants, Vidant Health, Greenville, North Carolina, United States of America.
T Ryan Gallaher, Department of Infectious Diseases, Vidant Health, Greenville, North Carolina, United States of America.
Diane Uschner, Department of Biostatistics and Bioinformatics, Biostatistics Center, George Washington University, Rockville, Maryland, United States of America.
Sharon L. Edelstein, Department of Biostatistics and Bioinformatics, Biostatistics Center, George Washington University, Rockville, Maryland, United States of America.
David M. Herrington, Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America.
John W. Sanders, Department of Internal Medicine, Section on Infectious Diseases, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America.

Document Type

Journal Article

Publication Date

1-1-2022

Journal

PloS one

Volume

17

Issue

3

DOI

10.1371/journal.pone.0260574

Abstract

INTRODUCTION: The COVID-19 Community Research Partnership is a population-based longitudinal syndromic and sero-surveillance study. The study includes over 17,000 participants from six healthcare systems in North Carolina who submitted over 49,000 serology results. The purpose of this study is to use these serology data to estimate the cumulative proportion of the North Carolina population that has either been infected with SARS-CoV-2 or developed a measurable humoral response to vaccination. METHODS: Adult community residents were invited to participate in the study between April 2020 and February 2021. Demographic information was collected and daily symptom screen was completed using a secure, HIPAA-compliant, online portal. A portion of participants were mailed kits containing a lateral flow assay to be used in-home to test for presence of anti-SARS-CoV-2 IgM or IgG antibodies. The cumulative proportion of participants who tested positive at least once during the study was estimated. A standard Cox proportional hazards model was constructed to illustrate the probability of seroconversion over time up to December 20, 2020 (before vaccines available). A separate analysis was performed to describe the influence of vaccines through February 15, 2021. RESULTS: 17,688 participants contributed at least one serology result. 68.7% of the population were female, and 72.2% were between 18 and 59 years of age. The average number of serology results submitted per participant was 3.0 (±1.9). By December 20, 2020, the overall probability of seropositivity in the CCRP population was 32.6%. By February 15, 2021 the probability among healthcare workers and non-healthcare workers was 83% and 49%, respectively. An inflection upward in the probability of seropositivity was demonstrated around the end of December, suggesting an influence of vaccinations, especially for healthcare workers. Among healthcare workers, those in the oldest age category (60+ years) were 38% less likely to have seroconverted by February 15, 2021. CONCLUSIONS: Results of this study suggest more North Carolina residents may have been infected with SARS-CoV-2 than the number of documented cases as determined by positive RNA or antigen tests. The influence of vaccinations on seropositivity among North Carolina residents is also demonstrated. Additional research is needed to fully characterize the impact of seropositivity on immunity and the ultimate course of the pandemic.

Department

Biostatistics and Bioinformatics

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