Association between self-reported signs and symptoms and SARS-CoV-2 antibody detection in UK key workers

Mulchandani, Ranya; Taylor-Philips, Sian; Jones, Hayley E.; Ades, A.E.; Borrow, Ray; Linley, Ezra; Kirwan, Peter D; Stewart, Richard; Moore, Philippa; Boyes, John; Hormis, Anil; Todd, Neil; Colda, Antoanela; Reckless, Ian; Brooks, Tim; Charlett, Andre; Hickman, Matthew; Oliver, Isabel; Wyllie, David

BACKGROUND: : Screening for SARS-CoV-2 antibodies is under way in some key worker groups; how this adds to self-reported COVID-19 illness is unclear. In this study, we investigate the association between self-reported belief of COVID-19 illness and seropositivity. METHODS: : Cross-sectional study of three key worker streams comprising (A) Police and Fire & Rescue (2 sites) (B) healthcare workers (1 site) and (C) healthcare workers with previously positive PCR result (5 sites). We collected self-reported signs and symptoms of COVID-19 and compared this with serology results from two SARS-CoV-2 immunoassays (Roche Elecsys® and EUROIMMUN). RESULTS: : Between 01 and 26 June, we recruited 2847 individuals (Stream A: 1,247, Stream B: 1,546 and Stream C: 154). Among those without previous positive PCR tests, 687/2,579 (26%) reported belief they had had COVID-19, having experienced compatible symptoms; however, only 208 (30.3%) of these were seropositive on both immunoassays. Both immunoassays had high sensitivities relative to previous PCR positivity (>93%); there was also limited decline in antibody titres up to 110 days post symptom onset. Symptomatic but seronegative individuals had differing symptom profiles and shorter illnesses than seropositive individuals. CONCLUSION: : Non-COVID19 respiratory illness may have been mistaken for COVID-19 during the outbreak; laboratory testing is more specific than self-reported key worker beliefs in ascertaining past COVID-19 disease.