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Barzin A, Schmitz JL, Rosin S, Sirpal R, Almond M, Robinette C, Wells S, Hudgens M, Olshan A, Deen S, Krejci P, Quackenbush E, Chronowski K, Cornaby C, Goins J, Butler L, Aucoin J, Boyer K, Faulk J, Alston-Johnson D, Page C, Zhou Y, Fiscus L, Damania B, Dittmer DP, Peden DB. SARS-CoV-2 Seroprevalence among a Southern U.S. Population Indicates Limited Asymptomatic Spread under Physical Distancing Measures. mBio 2020; 11:e02426-20. [PMID: 32994333 PMCID: PMC7527736 DOI: 10.1128/mbio.02426-20] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 12/27/2022] Open
Abstract
Characterizing the asymptomatic spread of SARS-CoV-2 is important for understanding the COVID-19 pandemic. This study was aimed at determining asymptomatic spread of SARS-CoV-2 in a suburban, Southern U.S. population during a period of state restrictions and physical distancing mandates. This is one of the first published seroprevalence studies from North Carolina and included multicenter, primary care, and emergency care facilities serving a low-density, suburban and rural population since description of the North Carolina state index case introducing the SARS-CoV-2 respiratory pathogen to this population. To estimate point seroprevalence of SARS-CoV-2 among asymptomatic individuals over time, two cohort studies were examined. The first cohort study, named ScreenNC, was comprised of outpatient clinics, and the second cohort study, named ScreenNC2, was comprised of inpatients unrelated to COVID-19. Asymptomatic infection by SARS-CoV-2 (with no clinical symptoms) was examined using an Emergency Use Authorization (EUA)-approved antibody test (Abbott) for the presence of SARS-CoV-2 IgG. This assay as performed under CLIA had a reported specificity/sensitivity of 100%/99.6%. ScreenNC identified 24 out of 2,973 (0.8%) positive individuals among asymptomatic participants accessing health care during 28 April to 19 June 2020, which was increasing over time. A separate cohort, ScreenNC2, sampled from 3 March to 4 June 2020, identified 10 out of 1,449 (0.7%) positive participants.IMPORTANCE This study suggests limited but accelerating asymptomatic spread of SARS-CoV-2. Asymptomatic infections, like symptomatic infections, disproportionately affected vulnerable communities in this population, and seroprevalence was higher in African American participants than in White participants. The low, overall prevalence may reflect the success of shelter-in-place mandates at the time this study was performed and of maintaining effective physical distancing practices among suburban populations. Under these public health measures and aggressive case finding, outbreak clusters did not spread into the general population.
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Affiliation(s)
- Amir Barzin
- The University of North Carolina at Chapel Hill School of Medicine, Department of Family Medicine, Chapel Hill, North Carolina, USA
| | - John L Schmitz
- The University of North Carolina at Chapel Hill School of Medicine, Department of Pathology and Laboratory Medicine and UNC Hospitals McLendon Clinical Laboratories, Chapel Hill, North Carolina, USA
- The University of North Carolina at Chapel Hill School of Medicine, Department of Microbiology and Immunology, Chapel Hill, North Carolina, USA
| | - Samuel Rosin
- The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Biostatistics, Chapel Hill, North Carolina, USA
| | - Rameet Sirpal
- UNC Physicians Network, Chapel Hill, North Carolina, USA
| | - Martha Almond
- The University of North Carolina at Chapel Hill School of Medicine, Center for Environmental Medicine, Asthma and Lung Biology, Chapel Hill, North Carolina, USA
| | - Carole Robinette
- The University of North Carolina at Chapel Hill School of Medicine, Center for Environmental Medicine, Asthma and Lung Biology, Chapel Hill, North Carolina, USA
| | - Samantha Wells
- The University of North Carolina at Chapel Hill School of Medicine, Department of Family Medicine, Chapel Hill, North Carolina, USA
| | - Michael Hudgens
- The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Biostatistics, Chapel Hill, North Carolina, USA
| | - Andrew Olshan
- The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, North Carolina, USA
| | - Stephanie Deen
- UNC Health Information Services Division, Chapel Hill, North Carolina, USA
| | - Patrick Krejci
- UNC Physicians Network, Chapel Hill, North Carolina, USA
| | - Eugenia Quackenbush
- The University of North Carolina at Chapel Hill School of Medicine, Department of Emergency Medicine, Chapel Hill, North Carolina, USA
| | - Kevin Chronowski
- The University of North Carolina at Chapel Hill School of Medicine, Department of Emergency Medicine, Chapel Hill, North Carolina, USA
| | - Caleb Cornaby
- The University of North Carolina at Chapel Hill School of Medicine, Department of Pathology and Laboratory Medicine and UNC Hospitals McLendon Clinical Laboratories, Chapel Hill, North Carolina, USA
| | - Janette Goins
- The University of North Carolina at Chapel Hill, North Carolina Translational and Clinical Sciences Institute, Chapel Hill, North Carolina, USA
| | - Linda Butler
- UNC REX Healthcare, Raleigh, North Carolina, USA
| | - Julia Aucoin
- UNC REX Healthcare, Raleigh, North Carolina, USA
| | - Kim Boyer
- UNC REX Healthcare, Raleigh, North Carolina, USA
| | - Janet Faulk
- UNC REX Healthcare, Raleigh, North Carolina, USA
| | | | - Cristen Page
- The University of North Carolina at Chapel Hill School of Medicine, Department of Family Medicine, Chapel Hill, North Carolina, USA
| | - Yijun Zhou
- The University of North Carolina at Chapel Hill School of Medicine, Department of Microbiology and Immunology, Chapel Hill, North Carolina, USA
- The University of North Carolina at Chapel Hill School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Lynne Fiscus
- UNC Physicians Network, Chapel Hill, North Carolina, USA
| | - Blossom Damania
- The University of North Carolina at Chapel Hill School of Medicine, Department of Microbiology and Immunology, Chapel Hill, North Carolina, USA
- The University of North Carolina at Chapel Hill School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Dirk P Dittmer
- The University of North Carolina at Chapel Hill School of Medicine, Department of Microbiology and Immunology, Chapel Hill, North Carolina, USA
- The University of North Carolina at Chapel Hill School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - David B Peden
- The University of North Carolina at Chapel Hill School of Medicine, Center for Environmental Medicine, Asthma and Lung Biology, Chapel Hill, North Carolina, USA
- The University of North Carolina at Chapel Hill, North Carolina Translational and Clinical Sciences Institute, Chapel Hill, North Carolina, USA
- The University of North Carolina at Chapel Hill School of Medicine, Department of Pediatrics, Chapel Hill, North Carolina, USA
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