SCIENTIFIC
COVID-19 : West Virginia Essential Workers and the Risks They Face
AUTHORS : Rayan Ihle , MD 1 , 2
Syed Kashif Mahmood , MD 1
1
Department of Internal Medicine , Division of Pulmonary Critical Care , Institute of Academic Medicine , Charleston Area Medical Center
2
Department of Internal Medicine , West Virginia University , Charleston Division
INTRODUCTION
The COVID-19 pandemic has and continues to be the most pressing healthcare issue of our lifetime , resulting in over 4 million deaths worldwide . As of July 28 , 2022 , the United States ( US ) ranked first in the world in the total number of cases at over 91 million leading to over 1,000,000 deaths . 1 West Virginia ( WV ) had seen over 550,000 cases as of late July 2022 , over 30 % of the total population . 2 Studies have indicated that COVID prevalence may be much more widespread than is being reported with polymerase chain reaction ( PCR ) or antigen tests . 3 , 4
ABSTRACT
INTRODUCTION The COVID-19 pandemic resulted in the need for antibody testing to determine the impact of the disease . This study quantifies the COVID-19 infection risk of healthcare workers ( HCW ) compared to other community essential workers ( CEW ) through positive COVID-19 antibody rates .
METHODS This prospective observational study was conducted September through December 2020 in Charleston , West Virginia . A total of 1,081 essential workers were recruited . Blood samples were tested for SARS-CoV-2 IgG antibodies and questionnaires were obtained describing symptom history , exposure , prior testing , and employment .
RESULTS COVID-19 antibodies were found in 7.8 % of participants . There were no significant differences in terms of gender , living alone or with children , month of lab collection , or working on a COVID-19 unit . Risk factors included having a known exposure ( p < 0.001 ), living with someone with COVID-19 ( p < 0.001 ), being previously tested ( p < 0.001 ), and positive polymerase chain reaction tests ( p < 0.001 ). Additional risks were county of residence ( p = 0.02 ) and working in healthcare ( p = 0.004 ).
DISCUSSION Essential workers had a nearly 60 % increased risk of COVID-19 compared with the public . HCW had a higher risk than other CEW with rates 1.8 times that of CEW . Living in Kanawha County was a risk factor , but the difference was driven by the HCW population with 12.1 % positivity . HCW in a COVID-19 unit had similar positive rates versus non-COVID-19 units .
CONCLUSION This study confirms that healthcare workers had a much higher risk of contracting COVID-19 near Charleston , WV . With these findings , despite the use of safety guidelines and use of personal protective equipment , healthcare workers in Kanawha County had higher positivity rates for SARS-CoV-2 IgG antibodies . Further evaluation of PPE compliance , hand hygiene habits , sharing work cultures , and roles within the hospital would be of value .
COVID-19 antibody testing was first approved by the Food and Drug Administration ( FDA ) under emergency use authorization in early 2020 . There are now more than 50 different COVID-19 antibody tests approved by the FDA . Serologic antibody testing identifies prior viral exposure and potential immunity ; however , further investigation is a topic of research to determine how antibodies decline over time . COVID-19 antibody tests detect COVID-19 IgG antibodies within one to three weeks after infection . 5 . 6
Antibody testing for COVID-19 may be a more accurate determination of disease pre valence than positive antigen or PCR tests since asymptomatic or minimally affected individuals can account for up to 80 % of cases and account for more than half of all transmission . 7 , 8 Healthcare workers ( HCW ) are at a much higher risk of contracting COVID-19 compared to the general public . 9 Essential workers during the COVID-19 pandemic not only included HCW , but also those in the energy , childcare , critical retail , critical trades , transportation , agriculture , and food production sectors who continued to be exposed to the general public during the first wave of COVID-19 . 10
During this study , WV was experiencing its first wave of COVID-19 infections with a cumulative positive rate of 4.95 %, a caseload of 80,000 patients , and 2,000 deaths . 2 Hospitalizations rose over five times with a peak of up to 800 hospitalized , 213 of which were in the intensive care units and 102 requiring mechanical ventilation . 2 Due to unavailability of a COVID vaccine , healthcare workers and other front-line workers in the community were at very high risk of contracting the virus . Previous studies have not been published comparing healthcare workers to other types of essential workers in the community . In this study , we aimed to determine the prevalence of SARS-CoV-2 antibodies in essential workers in and around Charleston , WV . We also hoped to better understand specific risk factors and demographics associated with COVID-19 infection . We hypothesized that HCW would have a higher prevalence of COVID-19 antibodies compared to other community essential workers ( CEW ) by providing direct care to COVID-19 positive patients .
METHODS
This prospective observational study was conducted September 1 through December 31 , 2020 , in Charleston , WV , and surrounding counties and was approved by the
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