Background Identifying factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among health care workers (HCWs) may help health systems optimize SARS-CoV-2 infection control strategies. Methods We conducted a cross-sectional analysis of baseline data from the Northwestern HCW SARS-CoV-2 Serology Cohort Study. We used the Abbott Architect Nucleocapsid IgG assay to determine seropositivity. Logistic regression models (adjusted for demographics and self-reported community exposure to coronavirus disease 2019 [COVID-19]) were fit to quantify the associations between occupation group, health care delivery tasks, and community exposure and seropositive status. Results A total of 6510 HCWs, including 1794 nurses and 904 non-patient-facing administrators, participated. The majority were women (79.6%), 74.9% were White, 9.7% were Asian, 7.3% were Hispanic, and 3.1% were non-Hispanic Black. The crude prevalence of seropositivity was 4.8% (95% CI, 4.6%–5.2%). Seropositivity varied by race/ethnicity as well as age, ranging from 4.2% to 9.6%. Out-of-hospital exposure to COVID-19 occurred in 9.3% of HCWs, 15.0% (95% CI, 12.2%–18.1%) of whom were seropositive; those with family members diagnosed with COVID-19 had a seropositivity rate of 54% (95% CI, 44.2%–65.2%). Support service workers (10.4%; 95% CI, 4.6%–19.4%), medical assistants (10.1%; 95% CI, 5.5%–16.6%), and nurses (7.6%; 95% CI, 6.4%–9.0%) had significantly higher seropositivity rates than administrators (referent; 3.3%; 95% CI, 2.3%–4.4%). However, after adjustment, nursing was the only occupation group with a significantly higher odds (odds ratio, 1.9; 95% CI, 1.3–2.9) of seropositivity. Exposure to patients receiving high-flow oxygen therapy and hemodialysis was significantly associated with 45% and 57% higher odds for seropositive status, respectively. Conclusions HCWs are at risk for SARS-CoV-2 infection from longer-duration exposures to people infected with SARS-CoV-2 within health care settings and their communities of residence.

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Background: The ExcelsiusGPS® (Globus Medical, Inc., Audubon, PA) is a next-generation spine surgery robotic system recently approved for use in the United States. The objective of the current study is to assess pedicle screw accuracy and clinical outcomes among two of the first operative cases utilizing the ExcelsiusGPS® robotic system and describe a novel metric to quantify screw deviation. Methods: Two patients who underwent lumbar fusion at a single institution with the ExcelsiusGPS® surgical robot were included. Pre-operative trajectory planning was performed from an intra-operative CT scan using the O-arm (Medtronic, Inc., Minneapolis, MN). After robotic-assisted screw implantation, a post-operative CT scan was obtained to confirm ideal screw placement and accuracy with the planned trajectory. A novel pedicle screw accuracy algorithm was devised to measure screw tip/tail deviation distance and angular offset on axial and sagittal planes. Screw accuracy was concurrently determined by a blinded neuroradiologist using the traditional Gertzbein-Robbins method. Clinical variables such as symptomatology, operative data, and post-operative follow-up were also collected. Results: Eight pedicle screws were placed in two L4-L5 fusion cases. Mean screw tip deviation was 2.1 mm (range 0.8-5.2 mm), mean tail deviation was 3.2 mm (range 0.9-5.4 mm), and mean angular offset was 2.4 degrees (range 0.7-3.8 degrees). All eight screws were accurately placed based on the Gertzbein-Robbins scale (88% Grade A and 12% Grade B). There were no cases of screw revision or new post-operative deficit. Both patients experienced improvement in Frankel grade and Karnofsky Performance Status (KPS) score by 6 weeks post-op. Conclusion: The ExcelsiusGPS® robot allows for precise execution of an intended pre-planned trajectory and accurate screw placement in the first patients to undergo robotic-assisted fusion with this technology.

The Excelsius GPS (Globus Medical, Inc.) was approved by the FDA in 2017. This novel robot allows for real-time intraoperative imaging, registration, and direct screw insertion through a rigid external arm—without the need for interspinous clamps or K-wires. The authors present one of the first operative cases utilizing the Excelsius GPS robotic system in spinal surgery. A 75-year-old man presented with severe lower back pain and left leg radiculopathy. He had previously undergone 3 decompressive surgeries from L3 to L5, with evidence of instability and loss of sagittal balance. Robotic assistance was utilized to perform a revision decompression with instrumented fusion from L3 to S1. The usage of robotic assistance in spinal surgery may be an invaluable resource in minimally invasive cases, minimizing the need for fluoroscopy, or in those with abnormal anatomical landmarks.The video can be found here: https://youtu.be/yVI-sJWf9Iw.

Objective: To determine the changes in SARS-CoV-2 serologic status and SARS-CoV-2 infection rates in healthcare workers (HCW) over 6-months of follow-up. Design: Prospective cohort study Setting and Participants: HCW in the Chicago area, USA Methods: Cohort participants were recruited in May/June 2020 for baseline serology testing (Abbott anti-Nucleocapsid IgG) and were then invited for follow-up serology testing 6 months later. Participants completed monthly online surveys which assessed demographics, medical history, COVID-19 illness, and exposures to SARS-CoV-2. The electronic medical record was used to identify SARS-CoV-2 PCR positivity during follow-up. Serologic conversion and SARS-CoV-2 infection or possible reinfection rates (cases per 10,000 person*days) by antibody status at baseline and follow-up were assessed. Results: 6510 HCW were followed for a total of 1,285,395 person*days (median follow-up, 216 days). For participants who had baseline and follow-up serology checked, 285 (6.1%) of the 4681 seronegative participants at baseline seroconverted to positive at follow-up; 138 (48%) of the 263 who were seropositive at baseline were seronegative at follow-up. When analyzed by baseline serostatus alone, 519 (8.4%) of 6194 baseline seronegative cohort participants had a positive PCR after baseline serology testing (rate = 4.25/10,000 person days). Of 316 participants who were seropositive at baseline, 8 (2.5%) met criteria for possible SARS-CoV-2 reinfection (PCR+ more than 90 days after baseline serology) during follow-up representing a rate of 1.27/10,000 days at risk. The adjusted rate ratio for possible reinfection in baseline seropositive compared to infection in baseline seronegative participants was 0.26, (95%CI: 0.13 – 0.53). Conclusions: Seropositivity in HCWs is associated with moderate protection from future SARS-CoV-2 infection.