In this study, we evaluated the seroprevalence of anti-SARS-CoV-2 antibodies among hospital staff with an overall prevalence of 2.9%5. In a previous study from Saudi Arabia, seroprevalence among HCWs was 2.36% with a statistical difference between hospitals who had COVID-19 cases with a prevalence of 2.9% vs. and 0.8% for hospitals that did not have COVID-19 cases5. Since our hospital admitted COVID-19 patients and had actively participated in the management of COVID-19 cases 12,13,14, thus the prevalence in our study is consistent with that of the nationwide prevalence among HCWs. However, more targeted HCWs who worked in the operating room and intensive care units showed a seroprevalence of 12.2% in a study from KSA15. A third study conducted June to August 2020 in KSA showed a higher rate of seropositivity of 32.2% in referral hospitals and quarantine sites16. In a study from Spain, seroprevalence among HCWs was 16.6% 17 and a longitudinal study in the United States showed a prevalence of 2.8% at baseline and 4.8% in a follow-up after six months18. During the first wave in Italy, 2.8% of HCWs tested seropositive19. Information about community prevalence of anti-SARS-CoV-2 antibodies may be used as a gauge of community immunity before the introduction of vaccines20. Such a study was done in KSA among blood donors and the seroprevalence was 1.4% 21 and is similar to those reported among HCWs in most of the KSA studies.
In our study, 112 (15.2%) participants had a positive SARS-CoV-2 rt-PCR before taking part in the study. The occurrence of SARS-CoV-2 infection among HCWs was found among 4.5% of 4462 patients in one hospital in KSA and 90.6% were community-acquired infection, and 61.3% of HCWs infection in Oman was also community-acquired 22. Another study described a hospital outbreak and thus 88% of infections in HCWs were hospital-acquired 23. However, we did not study the source of infection among those HCWs. It is important to note that the current pandemic of COVID-19 had occurred mainly among the communities with limited healthcare-associated outbreaks. This is an important distinction of the occurrence of multiple outbreaks in healthcare settings in the previous coronavirus, mainly the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia 24.
We evaluated the occurrence of symptoms among the 87 participants with a positive SARS-CoV-2 IgG assay. Those individuals experienced symptoms that were statistically significant compared to HCWs with negative serology. The most reported symptoms were fever 38 (43.6%), chills 32 (36.7%), muscle aches 47 (54%), fatigue 47 (54%), joint ache 33 (37.9%), loss of appetite 33 (37.9%), headache 44 (50.5%), general malaise 34 (39%), diarrhea 25 (28.7%), shortness of breath 22 (25.2%), cough 38 (43.6%), runny nose 26 (29.8%), and sore throat 32 (36.7%). These symptoms are not specific for COVID-19 patients. However, the occurrence of such symptoms had been reported among patients with COVID-19 as well. One study from KSA showed that the most common symptoms were cough (53.6%), fever (36.2%), fatigue (26.4%), dyspnea (21.9%), and sore throat (21.9%) 25 and similar symptomatology in other studies 23,26,27,28.
In 2020, a hospital in China conducted a study of obesity and its association with COVID-19 severity 29. The study concluded that patients who suffer from obesity have increased odds of developing and progressing to severe COVID-19 symptoms29. In this study, our findings showed that obesity is significantly associated with many COVID-19 symptoms as well more than any other comorbidity such as diabetes.
Elucidating factors associated with positive SARS-CoV-2 serology revealed two associated factors with positivity in bivariate analysis. These are always using alcohol-based hand rub or soap and water after (risk of) body fluid exposure and always wearing PPE when indicated. The data showed that those staff who were positive were less likely to wear PPE and to perform proper hand hygiene. The practice of hand hygiene is of paramount activity to reduce infection30. Multiple interventions were used to promote hand hygiene even before the current pandemic 30,31,32. Staff compliance with the hospital's robust Infection Prevention and Control program and guidance helped in maintaining the risk of infection and prevalence of SARS-CoV-2 amongst HCWs considerably low compared to other national and international healthcare organizations.
During the pandemic, isolation of suspected patients, the use of facemasks, and intensified hand hygiene were important for the prevention of nosocomial transmission of COVID-19 33. One study showed that multiple services were contaminated and had positive SARS-CoV-2 RNA 34. Another study from KSA showed high knowledge and practice scores in relation to hand hygiene and the use of masks 35. In a case-control study, frequent handwashing, social distancing, and avoidance of close contact were independently associated with a lower risk for SARS-CoV-2 infection 36.
One of the main limitations we exhibited in this study was the inability to categorize our participants into groups according to their level of exposure whether it was high or low to the virus / COVID-19 patients as this information was not comprehensively provided by the participants. In addition, due to the slow accrual, the study protocol was amended from randomized selection to open invitation which eventually resulted in achieving the targeted sample size (more than 10% of the hospital staff) at the expense of risk of selection bias. Finally, this study was conducted prospectively, participants depended fully on their memory and personal interpretation of their symptoms and association to the infection.
This study was carried out during the first wave of COVID-19 and before the availability of vaccination. Our findings showed that the positive seroconversion rate was considerably low amongst our healthcare workers and similar to other national and international healthcare organizations. Although the results of the study can be interpreted as a success in following the recommendations of the Intervention Prevention and Control Division, seropositivity correlated significantly with two factors of infection prevention which were appropriately alcohol-based hand rub or soap and water after the risk of body fluid exposure and wearing personal protective equipment when indicated