SARS-CoV-2 Screening Among Symptom-Free Healthcare Workers

ABSTRACT Importance Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is possible among symptom-free individuals and some patients are avoiding medically necessary healthcare visits for fear of becoming infected in the healthcare setting. Limited data are available on the point prevalence of SARS-CoV-2 infection in U.S. healthcare workers (HCW). Objective To estimate the prevalence of SARS-CoV-2 infection and to assess the acceptability of self-collected NPS among HCW. Design Cross-sectional convenience sample enrolled between April 20 th and June 24 th , 2020. We had >95% power to detect at least one positive test if the true underlying prevalence of SARS-CoV2 was ≥1%. Setting The metropolitan area surrounding Minneapolis and St. Paul, Minnesota. Participants HCW free of self-reported upper respiratory symptoms were recruited. Exposures Participants completed questionnaires regarding demographics, household characteristics, personal protective equipment (PPE) utilization and comorbidities. Outcomes A participant self-collected nasopharyngeal swab (NPS) was obtained. SARS-CoV-2 infection was assessed via polymerase chain reaction. NPS discomfort was assessed on a scale of 1 (no discomfort) – 10 (extreme discomfort). NPS duration and depth into the nasopharynx, and willingness to perform future self-collections were assessed. Results Among n=489 participants 80% were female and mean age±SD was 41±11. Participants reported being physicians (14%), nurse practitioners (8%), physician’s assistants (4%), nurses (51%), medics (3%), or other which predominantly included laboratory technicians and administrative roles (22%). Exposure to a known/suspected COVID-19 case in the 14 days prior to enrollment was reported in 40% of participants. SARS-CoV-2 was not detected in any participant. The mean±SD discomfort level of the NPS was 4.5±2.0. Participants overwhelmingly reported that their self-swabs was ≥ the duration and depth of patient swabs they had previously performed. Over 95% of participants reported a willingness to repeat a self-collected NP swab in the future. Conclusions and Relevance The point prevalence of SARS-CoV-2 infection was likely <1% in a convenience sample of symptom-free Minnesota healthcare workers from April 20 th and June 24 th , 2020. Self-collected NP swabs are well-tolerated and a viable alternative to provider-collected swabs to preserve PPE. KEY POINTS Questions What is the point prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among symptom-free healthcare workers (HCW) and what is the acceptability of self-collected nasopharyngeal swabs (NPS) for SARS-CoV-2 infection ascertainment? Findings SARS-CoV-2 was not detected in any of 489 HCWs studied. Self-collected NPS were well tolerated and over 95% of participants reported a willingness to repeat a self-collected NP swab in the future. Meaning The point prevalence of SARS-CoV-2 infection was likely very low in a convenience sample of symptom-free Minnesota healthcare workers from April 20 th and June 24 th , 2020.