Severe Acute Respiratory Syndrome Coronavirus 2 Seropositivity Among Healthcare Personnel in Hospitals and Nursing Homes

Rhode Island, USA, July-August 2020

Lara J. Akinbami; Philip A. Chan; Nga Vuong; Samira Sami; Dawn Lewis; Philip E. Sheridan; Susan L. Lukacs; Lisa Mackey; Lisa A. Grohskopf; Anita Patel; Lyle R. Petersen


Emerging Infectious Diseases. 2021;27(3):823-834. 

In This Article

Abstract and Introduction


Healthcare personnel are recognized to be at higher risk for infection with severe acute respiratory syndrome coronavirus 2. We conducted a serologic survey in 15 hospitals and 56 nursing homes across Rhode Island, USA, during July 17–August 28, 2020. Overall seropositivity among 9,863 healthcare personnel was 4.6% (95% CI 4.2%–5.0%) but varied 4-fold between hospital personnel (3.1%, 95% CI 2.7%–3.5%) and nursing home personnel (13.1%, 95% CI 11.5%–14.9%). Within nursing homes, prevalence was highest among personnel working in coronavirus disease units (24.1%; 95% CI 20.6%–27.8%). Adjusted analysis showed that in hospitals, nurses and receptionists/medical assistants had a higher likelihood of seropositivity than physicians. In nursing homes, nursing assistants and social workers/case managers had higher likelihoods of seropositivity than occupational/physical/speech therapists. Nursing home personnel in all occupations had elevated seropositivity compared with hospital counterparts. Additional mitigation strategies are needed to protect nursing home personnel from infection, regardless of occupation.


Healthcare personnel face higher risk of infection during the coronavirus disease (COVID-19) pandemic because of their essential role in identifying and treating persons affected.[1,2] Although essential workers in many occupations have higher risk of infection because of face-to-face interaction with the public, personnel in hospitals and nursing homes have more frequent and prolonged contact with persons known to be infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Hospitals and nursing homes are potential hotspots of infection transmission. Hospital personnel conduct activities ranging from infection screening to administering advanced life support measures and may be exposed to patients with high viral loads.[3] Infection risk can be exacerbated by shortages in personal protective equipment (PPE) and other resources, including staff.[4,5] Nursing homes have been referred to as "ground zero"[6] of the pandemic because resident deaths have contributed disproportionately to overall COVID-19 mortality.[2,7] Several factors may increase intrafacility transmission, including residents with risk factors for severe COVID-19 disease and prolonged viral shedding (e.g., advanced age, underlying conditions), a large proportion of asymptomatic infections, and new resource constraints alongside long-standing challenges.[8–11] Assessing SARS-CoV-2 seropositivity among hospital and nursing home personnel may reveal risk factors that can be addressed through additional interventions. Community transmission has been identified as a primary determinant of transmission in both nursing homes and hospitals,[12,13] but the relative impact in each of these settings has not been simultaneously compared.

The Rhode Island Department of Health (RIDOH) and the US Centers for Disease Control and Prevention (CDC) collaborated on a serologic survey of personnel in hospitals, nursing homes, and first responder agencies (e.g., fire, law enforcement) across Rhode Island. As of July 17, 2020, when the survey was initiated, there were >17,700 persons positive for COVID-19 in Rhode Island, of whom 2,675 were nursing home residents and 1,210 nursing home staff, and just more than 1,000 deaths, most among nursing home residents.[14] Because of the disproportionate impact on nursing homes, we made an added effort to include as many nursing home facilities as possible in the survey. This analysis compares SARS-CoV-2 seroprevalence among nursing homes and hospital personnel and assesses characteristics and factors related to seropositivity.