What is the SCORE Study?
SCORE is the acronym used for the study titled, "An Assessment of Serologic Evidence of COVID-19, Social and Occupational Contacts in Health Care Workers in a Sample of Long-Term Care and Acute Care Facilities in South Eastern Ontario". Research Ethics #6030636.
The study is a collaboration between Queen's University and the surrounding Public Health Units.
In Canada as of Sept 27, 2020, over 153,000 confirmed COVID-19 cases have been reported resulting in over 9,000 deaths1. Four of five deaths occurred in resident of long-term care facilities (LTC)2. Many health care workers (HCW) of LTC have been affected by COVID-19 in the past months, although with much less severe consequences.
Canadian provinces including Ontario have enhanced the infection control practices in LTC which added to social distancing norms will likely modify upcoming waves of COVID-19. We do not know to what extent this composite of responses will end up affecting the risk of COVID-19 outbreaks in LTC. However, we anticipate that LTC’s HCW are key as they can be a factor that halt the spread of COVID-19 within LTC (in the event that a visitor introduces it) and between the community and the LTC residents. In this regard, some HCW of LTC may have acquired antibodies against the SARS-CoV-2 (the virus that causes COVID-19) during a previous LTC outbreak and potentially also a degree of resistance to become reinfected with SARS-CoV-2.
Our study wants to measure the “antibody factor” and the “behavioural factor” of HCW in the following manner:
We will measure antibodies against SARS-CoV-2 in HCW who have worked in institutions affected by COVID-19 outbreaks or who have provided care to COVID-19 patients, and control HCW who have worked at institutions not affected by COVID-19.
We will apply a survey of occupational and social contacts HCW to estimate the risk that HCW have for acquiring or transmitting COVID-19 inside health care facilities and the community. This will allow run computer simulations with actual data to explore how reorganization of care within health care facilities can further reduce the risk of LTC COVID-19 outbreaks.
This study is a prospective cohort study of participants recruited from workers at the KHSC and LTC facilities in the KFL&A and other districts of South Eastern Ontario.
We will enroll all HCW that provided care to COVID-19 patients at the KHSC (where a dedicated COVID-19 unit and COVID-19 team are available, n~50), and a 1:1 sample of those who did not provide care. We will also invite HCW of one or two LTCs that experienced a COVID-19 outbreak and a random sample of HCW of one or two LTC from the KFL&A districts that did not have an outbreak. Sampling HCW at different levels of exposure will allow a more precise estimate of antibody responses in those conditions.
Health care workers will be invited to participate using ways acceptable to each institution which may involve one or more of the following: posters, personal invitation, mail, and e-mail. Individuals will be instructed to contact our team via phone or e-mail or via filling out a Qualtrics form that requests their name, e-mail address and phone number. We will then e-mail to each interested individual a link to the study questionnaire. The link to the study website is informative. The link to the study questionnaire is personalized to each participant and will first present consent form 1 (Qualtrics based), for them to read and sign. Once the individual has provided consent, he/she will have access to the questionnaire for him/her to complete. A phone number will be available for questions.
Data collection include:
1) Contact tracing data: We expect to find HCW who had to go through contact tracing and some who did not. For participants who did, we plan at a later time to obtain permission to collect contact tracing data from the Public Health Units records, once data transfer agreements have been completed. (Please, note that we are not yet requesting approval for this section of the study. We will request an amendment for this part of the study. We are summarizing the study protocol here).
2) Contact survey questionnaire: We will integrate a social contact diary and an occupational contact survey into one single questionnaire. The social contact diary survey is the English version of the one used in the POLYMOD study. The POLYMOD diary has been used to infer contact rates relevant to spread of respiratory infections, which can then be used to for mathematical modeling. To complete the dairy, participants will be assigned a random day of the week to record every person they had contact with between 5 a.m. and 5 a.m. the following morning.
3) Occupational data: information of possible exposure at work will be collected adapting previously developed questionnaires to the characteristics of the participating facilities.
4) We will remind participants of the cohort to notify us of incident symptoms and/or positive tests after their enrolment by means of monthly e-mail/text reminders.
5) A phlebotomist will draw blood from all participants once at time 0 and once 9-12 months later. A phlebotomy site is available at the Clinical Research Centre, Connell 4 of KGH for HCW recruited at this facility. For those recruited at Providence Manor, Hastings Manor and Stoneridge Manor, a site will be found at each of these facilities. Blood samples will be shipped to the KGH core lab for separation and aliquoting of serum and plasma. The samples will be stored at -80 until completion of the sampling.
6) Serologic tests: The Pathology Laboratory at KHSC has performed the technical validation of two serologic tests(led by Dr Yanping Gong, co-investigator). One is the Abbott Architect SARS-CoV-2 IgG and the second is the EUROIMMUN SARS-COV-2 ELISA (IgG). Both have acceptable accuracy and we will use one or both to test the samples.
Analysis of the data include: descriptive statistics, mathematical modeling, social network analysis
AIM 1: To measure the proportion of health care workers who have neutralizing antibodies against the SARS-CoV-2 spike protein at each health care setting.
AIM 2: To describe occupational and social contact patterns of HCW and perform comparisons between institutions (those with COVID-19 outbreaks vs. those without COVID-19 outbreaks) and between participants (those who had COVID-19 and those without COVID-19).
AIM 3: To devise possible options of using SARS-CoV-2 seroreactivity of HCW to reorganize care in LTC that contributes to reduce the risk of subsequent COVID-19 outbreaks.