Patterns of SARS-CoV-2 seropositivity among essential workers in long term care and retirement homes in Ontario, Canada: A descriptive cross-sectional study

Understanding patterns of SARS-CoV-2 seroprevalence among Long-Term Care Home and Retirement Home (LTCH/RH) staff is critical to designing effective public health interventions. We estimated SARS-CoV-2 seroprevalence among LTCH/RH staff in Ontario, Canada between May 2021-October 2022 using a cross-sectional analysis. Eligible participants completed a demographic questionnaire and provided a dried blood spot sample. Positive seroprevalence was defined as the proportion of individuals in a population who were positive for a SARS-CoV-2 infection, determined using anti-nucleocapsid total IgG antibodies analyzed with a validated chemiluminescent ELISA. We report age-adjusted prevalence ratios [PR; confidence interval, CI] by participant socio-demographic, household, neighbourhood, and occupational characteristics and stratified the analyses over two time periods (period 1: 2021-05-17 to 2021-12-31; period 2: 2022-01-02 to 2022-10-25). A total of 603 staff were included in our analysis; n=235 (39%) were enrolled in period 1 and n=368 (61%) were enrolled in period 2. Seroprevalence was 24% and 44% in periods 1 and 2, respectively. Age-adjusted prevalence ratios were nearly 2-fold higher among Black [PR 1.78; CI 1.28-2.48], East and Southeast Asian [PR 1.55, CI 1.18-2.04] and other racialized participants [PR 1.42, CI 1.03-1.96] compared to White participants. We did not observe a pattern across household characteristics, although we observed a trend towards higher seropositivity among participants living in COVID-19 hotspots. Prevalence ratios were lower for participants in higher income neighbourhoods [PR 0.72, CI 0.58-0.98]. We did not observe variability in seroprevalence across occupational characteristics with the exception of paid sick leave which was higher among participants with home-provided paid sick leave at the time of the survey [PR 0.58, CI 0.45-0.75]. Among LTCH/RH staff, we found important sources of variability of SARS-CoV-2 seroprevalence and strong correlations with socioeconomic disparities. Our findings show the importance of designing equity-rooted health interventions that recognize the intersection between community and the workplace.