The world is combating an ongoing COVID-19 pandemic with health-care systems, society and economies impacted in an unprecedented way. It is unclear how many people have contracted the causative coronavirus (SARS-CoV-2) unknowingly and are asymptomatic. Therefore, reported COVID-19 cases do not reflect the true scale of outbreak. Here we present the prevalence and distribution of antibodies to SARS-CoV-2 in a healthy adult population of the Netherlands, which is a highly affected country, using a high-performance immunoassay. Our results indicate that one month into the outbreak (i) the seroprevalence in the Netherlands was 2.7% with substantial regional variation, (ii) the hardest-hit areas showed a seroprevalence of up to 9.5%, (iii) the seroprevalence was sex-independent throughout age groups (18–72 years), and (iv) antibodies were significantly more often present in younger people (18–30 years). Our study provides vital information on the extent of exposure to SARS-CoV-2 in a country where social distancing is in place.

The world is combating an ongoing COVID-19 pandemic1-4. Health-care systems, society and the economy are impacted in an unprecedented way. It is unclear how many people have contracted the causative coronavirus (SARS-CoV-2) unknowingly. Therefore, reported COVID-19 cases do not reflect the true scale of outbreak5-9. Natural herd immunity has been suggested as a potential exit strategy during COVID-19 outbreaks, which may arise when 50-67% of a community has been infected10. Here we present the prevalence and distribution of antibodies to SARS-CoV-2 in a healthy adult population of a highly affected country using a novel immunoassay, indicating that one month into the outbreak (i) the seroprevalence in the Netherlands is 2.7% with substantial regional variation, (ii) the hardest-hit areas show a seroprevalence of up to 9.5%, (iii) the seroprevalence is sex-independent throughout age groups (18-72 years), (iv) antibodies are significantly more often detected in younger people (18-30 years), and (v) the number of immune individuals in the current epidemic stage is far below the herd immunity threshold. This study provides vital information on the extent of virus spread in a country where social distancing is in place, concluding that herd immunity to SARS-CoV-2 is not a realistic short-term exit strategy option.

BackgroundFrequent whole blood donors have an increased risk of developing iron deficiency. Iron deficiency can have detrimental health effects when left untreated. Donation intervals are commonly too short to replenish iron stores and extending these reduces donor availability. Oral iron supplementation is known to shorten iron store recovery time but may also induce gastrointestinal complaints. We aim to optimise the effectiveness of iron supplements while minimising the risks of side effects. Therefore, we will evaluate the impact of different iron supplementation protocols in terms of dosage and frequency on ferritin and haemoglobin levels, gastrointestinal side effects, iron deficiency-related symptoms and donor return compared with placebo supplementation.MethodsTwelve hundred whole blood donors with ferritin levels ≤30 µg/L are included into a double-blind, randomised controlled trial. Participants are randomly allocated to one of six arms, administering capsules containing 0 mg, 30 mg or 60 mg of iron, either on alternate days or daily for 56 days. At baseline and 56, 122 and 182 days of follow-up, ferritin and haemoglobin levels are measured, and compliance, donor return, dietary iron intake, gastrointestinal, iron deficiency-related symptoms and general health are assessed by questionnaire.Ethics and disseminationThis study will provide a comprehensive overview of the effects of different frequencies and dosages of administration of iron supplements on iron status and health effects, thereby considering individual differences in treatment adherence and lifestyle. The outcome will provide scientific evidence to guide the debate if and how oral iron supplements may support the recovery of whole blood donors with low ferritin levels.Trial registration numberNL8590; The Dutch trial registry.