When COVID-19 forced public health organizations to act, the universal strategy included social distancing, quarantine measures, comprehensive contact tracing and testing, mask wearing, and other strategies in order to prevent the virus from spreading. Enacting this strategy taxed public health infrastructure across the globe.

In many communities in the United States, this constellation of responses required local Boards of Health to significantly alter their operations. In Holyoke—a city in western Massachusetts with an approximately 53% Latinx population that was hard-hit early in the pandemic—the Board of Health changed many city employees’ roles, including having school nurses serve as contact tracers and sanitarians serve as COVID-19 compliance officers. To support this response, Holyoke partnered with the MGH Center for Global Health to help understand their community’s incidence of COVID-19 infection.

The Holyoke Board of Health and MGH launched the Holyoke COVID-19 Community Antibody Study, a seroprevalence study designed to help Holyoke measure the incidence of SARS-CoV-2—the virus that causes COVID-19—and help the Board of Health respond to the pandemic. A seroprevalence study measures the number of persons in a population who test positive for antibodies against a specific disease, indicating they have been exposed in the past.

We spoke with Ryan Paxton, MPH, sanitarian at the Holyoke Board of Health, to discuss Holyoke’s partnership with CGH.

What follows is an interview with Ryan Paxton, lightly edited for clarity.

Can you describe the Holyoke COVID-19 Community Antibody Study?

The project we did with the MGH Global Health Initiative was a seroprevalence study. This study essentially involved sampling 2,000 random households in Holyoke.

We asked households to participate, which involved completing a survey that asked a lot of demographics information, information about potential exposure, household situation, where they work, and more.

If they agreed to do the survey, they were also asked to provide a blood sample. We were able to send that to a lab [at MGH] to check for antibodies [for SARS-CoV-2 which produces COVID-19].

Why did you conduct this study in Holyoke?

The main reason was to see what portion of the study population had been infected with COVID-19 at some point in time. We also wanted to see what level of immunity was present throughout the community and look at whether or not there were disparities within that.

What was your role on the team?

I am the point person in Holyoke, while most of the team works out of MGH. I worked on data collection and working on the more macro side with organization and logistics. I plugged in wherever I was needed.

What have you found as a result of the research?

First thing is that, out of our sampling, the data suggested that the overall seroprevalence of COVID-19 antibodies in the city was approximately 13.9%. This is approximately double the number of our reported cases in the city.

Can you explain this difference further?

The data that was previously available via confirmed PCR testing in the MAVEN (Massachusetts Virtual Epidemiologic Network) database only captured about half of what our study data suggests was the case in the city. This was probably the biggest conclusion: the regular testing protocol does not fully capture the whole caseload of the city and there are probably a lot of undiagnosed, untested individuals.

Were there other important conclusions?

The next main conclusions are where the disparities in the community come in. The Latinx population had a seroprevalence rate around 16.8% compared to individuals identifying as white having a rate of 8.9%. This was very in-line with national trends that documented racial and ethnic disparities in various communities.

We [also] saw that both people over 85 years of age and younger groups have higher seroprevalence rates.

A final conclusion was that seroprevalence was higher among people reporting household contact with someone with COVID-19. This led us to believe that household transmission was a significant risk factor. [Before the study] we saw a lot of people getting COVID-19 without having household exposure, but the study data indicated otherwise. It seems that a lot of transmission was at home.

Why do you think that is?

During the pandemic, there was an assumption that people could maintain proper isolation and quarantining in their own home and thus prevent the spread from one individual to another. As we found, that does not seem to be the case.

Not everybody has the physical capacity to be completely quarantined or isolated from other individuals in their house. For example, if there is only one bathroom or people sharing bedrooms and things like that.

How has the research informed the Department of Health’s response to the COVID-19 pandemic?

It was very clear that we would have to focus on making both testing and vaccinations as accessible as possible—particularly to lower income and denser portions of our city—to ensure equitable access. We did try to do that to the best of our ability: we had vaccination buses that were sent from the state that were available here, we had vaccination sites at the Holyoke mall, and we actually had two mass Stop the Spread testing sites, one of which was accessible via foot traffic which is not necessarily the norm in testing sites. I believe that we bolstered accessibility through our response and through contact tracing, epidemiology, and surveillance.

Ultimately, we are here to protect the health of the community, but we do not necessarily interact with a very large number of individuals unless they reach out to us, or we are already engaged with them in some capacity. This study was a great opportunity that involved a lot of hands-on work we do not always have a lot of bodies to do, but the work was very helpful and insightful in [navigating the pandemic].

Find a summary of results here.

Thank you to the study team: Louise Ivers, MD, MPH, Principal Investigator, Wilfredo Matias, MD, MPH, Isabel Fulcher, PhD, Yodeline Guillaume, MA, Niame Daffe, Kerry Phelan, MBA, and Jack Zhu, MPH.

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