LAUSR

Objectives Estimate incidence of and risks for SARS-CoV-2 infection among nursing home staff in the state of Georgia during the 2020/2021 Winter COVID-19 Surge in the U.S. Design Serial survey and serologic testing at two time points with 3-month interval exposure assessment. Setting and Participants 14 nursing homes in the state of Georgia. 203 contracted or employed staff members from 14 participating nursing homes who were seronegative at first timepoint and provided a serology specimen at second timepoint, at which time they reported no COVID-19 vaccination or only very recent vaccination (≤4 weeks). Methods Interval infection was defined as seroconversion to antibody presence for both nucleocapsid protein and spike protein. We estimated adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) by job type, using multivariable logistic regression, accounting for community-based risks including interval community-incidence and interval change in resident infections per bed. Results Among 203 eligible staff, 72 (35.5%) had evidence of interval infection. In multivariable analysis among unvaccinated staff, staff SARS-Cov-2 infection induced seroconversion was significantly higher among nurses and certified nursing assistants accounting for race and interval infection incidence in both the community and facility (aOR 5.3, 95% CI 1.0-28.4). This risk persisted but was attenuated when utilizing the full study cohort including those with very recent vaccination. Conclusions and Implications Midway through the first year of the pandemic, job type continues to be associated with increased risk for infection despite enhanced infection prevention efforts including routine screening of staff. These results suggest that mitigation strategies, prior to vaccination did not eliminate occupational risk for infection and emphasize critical need to maximize vaccine utilization to eliminate excess risk among front line providers.