Beaumont Health is an eight-hospital regional health care system with a total of 3,337 beds,
38,000 employees and 5,000 physicians in Southeast Michigan. In the first 3 weeks of the
COVID-19 pandemic within Michigan over 3300 patients tested positive through our system and
over 1000 have been admitted for inpatient care. COVID-19 has a wide range of presentations
from asymptomatic to multisystem organ failure and death. Spread from asymptomatic
individuals has been described in the literature but the extent of this transmission is
unclear. Large scale serologic testing can help address this question by detecting antibodies
generated after an individual is infected with COVID-19. Healthcare workers have developed
COVID-19 but the true infection rate among those who care for COVID-19 patients and whether
the infection occurs at work is unknown.

Every day, thousands of Beaumont physicians, nurses, technicians and other caregivers are
working under extraordinary stress, doing their very best to care for patients with this
highly contagious and potentially deadly virus. They are trying to protect themselves from
infection while dealing with personal protective equipment requirements and limited knowledge
of who in the hospital environment may be carrying the infection and potentially spreading it
among the staff. Caregivers are at greater risk of infection than the public, and when they
become sick, it reduces the number of trained personnel available to care for hospitalized
patients. Serological testing would give Beaumont's front-line staff, family members and
patients peace of mind by determining infection rates in our care units. Knowing the
infection rates will demonstrate how effective the use of personal protective equipment has
been for staff, whether any flaws exist in the system, and how many clinical staff currently
have potentially protective antibodies.

Beaumont Health has 2 EURO Lab Workstations capable of running the SARS-CoV-2 IgG and IgA
EUROIMMUN serology assay (referred to as the EUROIMMUN assay hereafter). Each EUROIMMUN assay
consists of 2 separate tests; one of which measures IgG (the memory antibody which should
give long acting resistance to people who mount an immune response) and the second of which
measures IgA (the secretory antibody that should protect against infection through mucous
membranes). Researchers can run 5,000 samples a day with each sample being tested for IgA and
IgG.

Potential participants (employees and affiliated non-employed physicians and advanced
practice providers) will provide informed consent. Researchers will analyze all participants
over 2 blood draws between 2 and 4 weeks apart to see if they developed antibodies to
COVID-19. Participants at medium risk for exposure in their job function at Beaumont will
have 3 draws 2-4 weeks apart and people considered the highest risk, those who provide the
direct patient care to COVID-19 patients, will be tested 2-4 weeks apart until the pandemic
in Michigan is under control (estimated to be 8 blood draws). If the participants agree,
researchers will bank 0.5 ml of serum for future testing related to COVID-19. An initial
questionnaire and subsequent questionnaires with each blood draw will be completed by
participants. Biostatistics will analyze the data from the questionnaires and the serology
test to determine any links between level of risk associated with the participants job,
medical history, and exposure history to development of COVID-19 antibodies. Participants
medical records will be monitored for one year to see if they are diagnosed with COVID-19 and
if they have a positive PCR test for COVID-19 since they were tested for the presence of
antibodies. All employees identified as developing COVID-19 after their antibody levels were
tested will be analyzed and a correlation between antibody level and development of COVID-19
will be generated. This will allow an estimation of the protective effect of antibodies
relative to people who have no detectable antibodies. Researchers will perform an
epidemiologic analysis to identify contacts between staff and patients based on records in
the EMR and can cross reference to determine if nosocomial transmission is likely occurring
from staff to patients and vice versa. Researchers will also determine if there was any
likely exposure to patients with COVID-19 on the same floor or if prior patients in the room
had COVID-19. This will also allow researchers to model the rate of spread of the virus
within the hospital from unknown sources.

Additional studies on subpopulations of participants will test whether antibody tests on
dried blood spots (small drops of blood applied to filter paper, which do not have to be
refrigerated) correlate with results obtained from drawing a full vial of blood.
Reproducibility, stability, the effect of shipping, inter-lab concordance and any differences
between participant-collected and phlebotomist-collected blood spot samples will be tested.

An additional subpopulation study will test immediate family members of participants who test
positive for SARS-CoV-2 antibodies to evaluate intra-family spread of the disease. Another
subpopulation study will recruit participants from other high-risk populations at the
discretion of the investigators.