A cross-section observational study on the seroprevalence of antibodies to COVID-19 in patients receiving opiate agonist treatment

Abstract

Introduction The HSE National Drug Treatment Centre is an inner city drug treatment centre in Dublin which provides opiate agonist treatment (OAT) to approximately 565 patients, many of whom have complex care needs. Objective This study was conducted to determine seropositivity to the COVID-19 virus in patients attending NDTC, and to establish if patients tested had any clinical symptoms of this disease since March 2020. Method All patients attending for OAT were invited to participate and 103/565 patients agreed. The patients were tested for the presence of serum antibodies to COVID-19 in a single sample collected over a 4-month period (July-October 2020). A questionnaire was administered at the same time as sample taking. Results Results showed that the majority of patient samples (100; 97%) tested were negative for the presence of antibodies to COVID-19. There were only two confirmed positive results (1.9%) and one equivocal result (1%). None of the approximately 565 attendees at the HSE NDTC presented with serious illness indicative of COVID-19 throughout the three waves of the pandemic, nor were any deaths due to COVID-19 reported. Conclusion These findings indicate (a) possible low level of exposure to COVID-19 among this patient cohort or (b) that those patients who have been exposed have not developed or maintained detectable antibody levels, nor developed symptoms of the disease. Public health measures could explain the low level of COVID-19 in this cohort. The findings are also consistent with the possibility of a protective effect of OAT medications on development of the disease.

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“…Second, in this study, more than 1600 drug addicts were included. This number is quite high compared to previous studies investigating prevalence rates of SARS-CoV-2 in Switzerland (n = 122; [11] and Ireland (n = 103, [12]). However, compared to populationbased samples, which were calculated in 100,000 persons, our sample is relatively small.…”

“…Eventually, the observation period was about 12 months compared to 4–5 months in previous studies in Ireland 12 and Switzerland 11 , respectively. In addition, our data were gathered from several centres instead of a monocentric approach.…”

“…In a Swiss study, the infection rate among patients under opioid maintenance treatment (OMT) (n = 122) was nearly 3-fold increased, compared with a sample from the general population (n = 472) of about the same age during an observation period of about two months, but none of the 12 OMT patients who tested positive showed a severe course [11]. In an Irish study, which was conducted during the second wave of the pandemic at an inner city drug treatment centre offering OMT, none of the approximately 565 attendees reported signs of serious illness from COVID-19, and 97 % of n = 103 OMT patients who agreed in being tested were negative for the presence of antibodies to COVID-19, which was a lower proportion than for the local general population [12]. In a Spanish study conducted in 2020, only 6 out of 2078 patients with COVID-19 pneumonia admitted to an urban hospital were opioid dependent (0.3 %) [13].…”

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“…Furthermore, COVID-19 symptoms are more or less unspecific and very close to those of an opioid withdrawal; they might not be perceived as such of a COVID-19 infection [6]. While Fenton et al [23] tested in an Irish study of 103 patients at a national drug treatment center, only two individuals with positive SARS-CoV-2 antibodies, Bruggmann et al [24] found a more than twofold higher SARS-CoV-2 seroprevalence among OAT patients (9.8%) in Zurich (Switzerland) compared to the general population (3.5%), whereas both studies did not identify patients with a severe disease progression. A nationwide cohort study in the USA suggests that people with OUD and COVID-19 have a higher risk of worse COVID-19 outcomes and that especially younger age and no medication treatment for OUD are risk factors for dying due to COVID-19 [25].…”