Estimating exposure to SARS-CoV-2 at the Arab International University, Syria: a snapshot after a year of pandemic

Background: After a year of pandemic in Syria, how prevalent the seropositivity is, and how far we are from herd immunity is a raised question. Aim: Our study aimed to estimate the overall exposure to SARS-COV-2 depending on the COVID-19-specific symptoms as well as the seroprevalence of anti-SARS-CoV-2 IgG antibodies among students and staff at the Arab International University (AIU) in Syria. Methods: All AIU students and staff were invited to voluntarily participate in the study by filling out and submitting an anonymous web-based survey. Responses were evaluated then asymptomatic and pauci-symptomatic respondents were notified of a phlebotomy appointment. Anti-SARS-CoV-2 IgG antibodies were analyzed by ELISA. Results: One third (122 of 381; 32%) of respondents were asymptomatic. The remaining respondents reported COVID-19-specific symptoms (177 of 381; 46.5%), mainly anosmia and/or ageusia (132 of 177; 74.5%), or nonspecific symptoms (82 of 381; 21.5%). Frequencies of symptoms onset showed a strong, positive correlation with the incidence of confirmed SARS-CoV-2 RNA-positive cases reported by the Ministry of Health in Syria. Anti-SARS-CoV-2 IgG antibodies were similarly detected in both symptomatic (21 of 33; 63.6%) and asymptomatic (39 of 61; 63.9%) individuals (P=.97). Conclusions: After a year of pandemic, a 69% exposure to SARS-CoV-2 is roughly estimated amongst asymptomatic and pauci-symptomatic individuals. Further post-vaccination assessment of seroprevalence against SARS-CoV-2 in future large-scale studies might provide a more complete picture of the SARS-CoV-2 epidemic in Syria.