Purpose Seroprevalence surveys from different countries have reported SARS CoV-2 antibodies below 20% even in the most adversely affected areas and herd immunity cannot be predicted till more than half of the population gets the disease. The purpose of this survey was to estimate the magnitude of community-based spread of the infection, associated immunity, and the future prospects and proximity to a 'herd community'. Methods The study was undertaken as a cluster randomized, cross-sectional countrywide survey. This largest communitybased seroprevalence data of SARS-CoV-2 were collected between 15th and 31st July, 2020 from seven randomly selected cities belonging to the three most populous provinces of Pakistan. The FDA approved kit of ROCHE was used for detection of SARS-CoV-2 antibodies. Results Serum samples of 15,390 participants were tested for SARS CoV-2 antibodies with an overall seroprevalence of 42.4%. The seroprevalence ranged from 31.1% to 48.1% in different cities with the highest in Punjab province (44.5%). In univariable analysis, the odds of seropositivity was higher in men compared to women (OR: 1.10, 95% CI: 1.01-1.19, P < 0.05). In multivariable analysis, the risk of being seropositive was lower (OR 0.72, 95% CI: 0.60-0.87, P < 0.01) in younger group (≤ 20 years) than in those aged above 60 years. ConclusionThe study concluded that despite a reasonable seroprevalence, the country is yet to reach the base minimum of estimations for herd immunity. The durability of immunity though debated at the moment, has shown an evidenced informed shift towards longer side.

Background Nurses and paramedics by being the frontline workers of the healthcare profession need to be equipped with the relevant knowledge, skills and protective gears against different forms of infection, including COVID-19. Though the governments and concerned stakeholders have provided P.P.E.s, training and information to protect the healthcare professionals, however until now the scientific literature has virtually not reported the impact of P.P.Es availability, training and practices on the COVID-19 sero-prevalence among the nurses and paramedics. Objective This study aimed to assess the Impact of P.P.Es availability, training and practices on COVID-19 sero-prevalence among nurses and paramedics in teaching hospitals of Peshawar, Pakistan. Methods A cross-sectional survey was conducted with a total of 133 nurses and paramedics as subjects of the study. Results A univariate analysis was done for four variables. The findings indicate that the healthcare professionals (nurses & paramedics) who have received P.P.Es on time at the start of COVID-19 emergence has fewer chances of contracting the COVID-19 infection (O.R = 0.96); while the odds for P.P.Es supplies was 0.73, and the odds of hand hygiene training was 0.95. Conclusion The study concluded that the availability of the P.P.E.s, COVID-19 related training and compliance with W.H.O recommended practices against COVID-19 were instrumental in protection against the infection and its spread.

Background: High number of SARS CoV2 infected patients has overburdened healthcare delivery system, particularly in low-income countries. In the recent past many studies from the developed countries have been published on the prevalence of SARS CoV2 antibodies and the risk factors of COVID 19 in healthcare-workers but little is known from developing countries. Methods: This cross-sectional study was conducted on prevalence of SARS CoV2 antibody and risk factors for seropositivity in HCWs in tertiary care hospitals of Peshawar city, Khyber Pakhtunkhwa province Pakistan. Findings: The overall seroprevalence of SARS CoV2 antibodies was 30.7% (CI, 27.8 to 33.6) in 1011 HCWs. Laboratory technicians had the highest seropositivity (50.0%, CI, 31.8 to 68.1). Risk analysis revealed that wearing face-mask and observing social-distancing within a family could reduce the risk (OR:0.67. p<0.05) and (OR:0.73. p<0.05) while the odds of seropositivity were higher among those attending funeral and visiting local-markets (OR:1.83. p<0.05) and (OR:1.66. p<0.01). In Univariable analysis, being a nursing staff and a paramedical staff led to higher risk of seropositivity (OR:1.58. p< 0.05), (OR:1.79. p< 0.05). Fever (OR:2.36, CI, 1.52 to 3.68) and loss of smell (OR:2.95, CI: 1.46 to 5.98) were significantly associated with increased risk of seropositivity (p<0.01). Among the seropositive HCWs, 165 (53.2%) had no symptoms at all while 145 (46.8%) had one or more symptoms. Interpretation: The high prevalence of SARS CoV2 antibodies in HCWs warrants for better training and use of protective measure to reduce their risk. Early detection of asymptomatic HCWs may be of special importance because they are likely to be potential threat to others during the active phase of viremia. Funding: Prime Foundation Pakistan.

Objective: The objective of this study was to evaluate the magnitude and durability of the anti-nucleocapsid-IgG antibody titer in healthcare workers previously infected with SARS-CoV-2 for a period of 12 months. Methods: This study examined blood samples for SARS-CoV-2-specific IgG collected periodically from 120 healthcare workers previously infected with SARS-CoV-2 (confirmed by RT-PCR) and followed longitudinally up to 12 months from their enrolment into the study. Results: The median anti-N-IgG antibody level identified at 3 months was 23.7 CO-index (IQR: 9.13–50.27) and increased to 32.9 CO-index (IQR: 11.8–84.4) at 6 months. At 9 months, the median anti-N-IgG antibody level started to wane in the subsequent time and was dropped to 14 CO-index (IQR: 3.4–37.6) and declined further to 9.8 CO-index at 12 months (IQR: 2.8–9.8). When classified by age groups, the only statistically significant difference in anti-N-IgG between the two age groups (≤30 years and >30 years) was identified at 12 month time point (median difference 8.06, p = 0.035). Spearman correlation coefficient was negatively associated between anti-N-IgG and time interval ( r = −0.255, p = 0.000) but was not statistically significant with age of a patient ( p > 0.05). Conclusions: In conclusion, SARS-CoV-2 antibody levels started declining after 6 months but remained detectable in the majority of patients up to 12 months.

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