SARS-COV-2 antibody prevalence in patients on dialysis in the US in January 2021

Abstract

Background: To estimate seroprevalence of SARS-CoV-2 antibodies in the US, the country with largest absolute numbers of COVID19 cases and deaths in the world, we conducted a cross-sectional assessment from a sample of patients receiving dialysis in January 2021. Methods: We tested remainder plasma of 21,424 patients receiving dialysis through the third-largest US dialysis organization, with facilities located nationwide. We used the Siemens spike protein receptor binding domain total antibody assay to estimate crude SARS-CoV-2 seroprevalence, and then estimated seroprevalence for the US dialysis and adult population by standardizing by age, sex and region. We also compared January 2021 seroprevalence and case-detection rates to that from a similar subsample of patients receiving dialysis who had been tested in July 2020. Results: Patients in the sample were disproportionately from older age and minority race/ethnic groups. Seroprevalence of SARS-CoV-2 was 18.9% (95% CI: 18.3-19.5%) in the sample, 18.7% (18.1-19.2%) standardized to the US dialysis population, and 21.3% (20.3-22.3%) standardized to the US adult population (range 15.3-20.8% in the Northeast and South respectively). Younger age groups (18-44 years), and persons self-identifying as Hispanic or living in Hispanic neighborhoods, and persons living in the poorest neighborhoods were among the subgroups with the highest seroprevalence (25.9% (24.1-27.8%), 25.1% (23.6-26.4%), 24.8% (23.2-26.5%) respectively). Compared to data from July 2020, we observed diminished variability in seroprevalence by geographic region and urban-rural status. Estimated case detection rate increased from 14% to 23% in July 2020 to January 2021. Conclusions: A year after the first case of SARS-CoV-2 infection was detected in the US, fewer than one in four adults have evidence of SARS-CoV-2 antibodies. Vaccine roll out to majority minority neighborhoods and poorer neighborhoods will be critical to disrupting the spread of infection.

Progression of SARS-CoV-2 Seroprevalence in St. Louis, Missouri, through January 2021

“…For samples collected in January 2021, the estimated seroprevalence rates are 19.03% (95% CrI, 15.24% to 22.80%) for adults and 21.16% (95% CrI, 17.21% to 25.09%) for the pediatric cohort. These rates are similar to the 18.9% seroprevalence rate found in patients receiving dialysis across 43 states in January 2021 ( 6 ).…”

On the use of the Reproduction Number for SARS-COV-2: Estimation, Misinterpretations and Relationships with other Ecological Measures

“…Whereas early modelling work demonstrated the potential for severe and protracted outbreaks in the absence of effective vaccination (Ferguson et al, 2020 ; Kissler et al, 2020 ), subsequent theoretical studies suggested that heterogeneity in individual risk of acquiring or transmitting infection could lower such thresholds (Britton et al, 2020 ), including to implausibly low values in the range of 10–20% (Aguas et al, 2020 ). The validity of these conclusions that transmission could be brought under control with low population immunity has ultimately been brought into question by the persistence of severe epidemics with R > 1 even amid high population seroprevalence and aggressive vaccine rollout (Anand et al, 2021 ; Buss et al, 2021 ; Malani et al, 2021 ). Related debate has surrounded the interpretation of early R 0 estimates in light of the possibility for immunological cross‐recognition of SARS‐CoV‐2 among individuals with recent exposure to endemic coronaviruses (Lourenço et al, 2020 ).…”