Serology characteristics of SARS-CoV-2 infection since the exposure and post symptoms onset

Liu, Bin; Li, Tigndong; Zheng, Shufa; Su, Yingying; Li, Zhiyong; Yu, Fei; Ge, Shengxiang; Zou, Qianda; Yuan, Quan; Lin, Sha; Hong, Congming; Yao, Xiangyang; Zhang, Xuejie; Wu, Dinghui; Zhou, Guoliang; Hou, Wangheng; Li, Tingting; Zhang, Yali; Zhang, Shiyin; Fan, Jian Gao; Zhang, Jun; Xia, Ningshao; Chen, Yu

doi:10.1101/2020.03.23.20041707

Cited by 87 publications

(101 citation statements)

References 16 publications

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“…The electronic search revealed 115 articles from PubMed, 72 from medRxiv and 12 from bioRxiv, from which we identified 38 eligible studies after scrutiny [25][26][27][28][29][30][31][32][33][34][35][36][37] (Figure 1). These include in total 7,848 individuals (3,522 COVID-19 cases and 4,326 healthy, or non COVID-19, individuals).…”

Section: Resultsmentioning

confidence: 99%

Antibody tests in detecting SARS-CoV-2 infection: a meta-analysis

Kontou

Braliou

Dimou

et al. 2020

Preprint

127

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With the emergence of SARS-CoV-2 and the associated Coronavirus disease 2019 (COVID-19), there is an imperative need for diagnostic tests that can identify the infection. Although Nucleic Acid Test (NAT) is considered to be the gold standard, serological tests based on antibodies could be very helpful. However, individual studies measuring the accuracy of the various tests are usually underpowered and inconsistent, thus, a comparison of different tests is needed. We performed a systematic review and meta-analysis following the PRISMA guidelines. We conducted the literature search in PubMed, medRxiv and bioRxiv. For the statistical analysis we used the bivariate method for meta-analysis of diagnostic tests pooling sensitivities and specificities. We evaluated IgM and IgG tests based on Enzyme-linked immunosorbent assay (ELISA), Chemiluminescence Enzyme Immunoassays (CLIA), Fluorescence Immunoassays (FIA) and the point-of-care (POC) Lateral Flow Immunoassays (LFIA) that are based on immunochromatography. In total, we identified 38 eligible studies that include data from 7,848 individuals. The analyses showed that tests using the S antigen are more sensitive than N antigen-based tests. IgG tests perform better compared to IgM ones, and show better sensitivity when the samples were taken longer after the onset of symptoms. Moreover, irrespective of the method, a combined IgG/IgM test seems to be a better choice in terms of sensitivity than measuring either antibody type alone. All methods yielded high specificity with some of them (ELISA and LFIA) reaching levels around 99%. ELISA- and CLIA-based methods performed better in terms of sensitivity (90-94%) followed by LFIA and FIA with sensitivities ranging from 80% to 86%. ELISA tests could be a safer choice at this stage of the pandemic. POC tests (LFIA), that are more attractive for large seroprevalence studies show high specificity but lower sensitivity and this should be taken into account when designing and performing seroprevalence studies.

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Section: Resultsmentioning

confidence: 99%

Antibody tests in detecting SARS-CoV-2 infection: a meta-analysis

Kontou

Braliou

Dimou

et al. 2020

Preprint

127

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“…In addition, our model assumes that immunity has fast onset (2-3 weeks) and is permanent in duration. Clinical work at Zhejiang University, China, suggests that seroconversion of total antibody, IgM and IgG antibodies developed with a median period of 15, 18 and 20 days post exposure, respectively, for symptomatic patients in a hospital 32 . The effects of shield immunity are robust in a scenario where the duration of immunity is four months or longer (Extended Data Figs.…”

Section: Main Findings and Limitationsmentioning

confidence: 99%

Modeling shield immunity to reduce COVID-19 epidemic spread

Weitz

Beckett

Coenen

et al. 2020

Nat Med

233

210

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The COVID-19 pandemic has precipitated a global crisis, with more than 1,430,000 confirmed cases and more than 85,000 confirmed deaths globally as of 9 April 2020 1-4 . Mitigation and suppression of new infections have emerged as the two predominant public health control strategies 5 . Both strategies focus on reducing new infections by limiting human-to-human interactions, which could be both socially and economically unsustainable in the long term. We have developed and analyzed an epidemiological intervention model that leverages serological tests 6,7 to identify and deploy recovered individuals 8 as focal points for sustaining safer interactions via interaction substitution, developing what we term 'shield immunity' at the population scale. The objective of a shield immunity strategy is to help to sustain the interactions necessary for the functioning of essential goods and services 9 while reducing the probability of transmission. Our shield immunity approach could substantively reduce the length and reduce the overall burden of the current outbreak, and can work synergistically with social distancing. The present model highlights the value of serological testing as part of intervention strategies, in addition to its well-recognized roles in estimating prevalence 10,11 and in the potential development of plasma-based therapies 12-15 .In the absence of reliable pharmaceutical interventions against SARS-CoV-2, multiple public health strategies are being deployed to slow the coronavirus pandemic 1,5,16 . These strategies can be broadly grouped into two approaches: mitigation and suppression. Mitigation includes a combination of social distancing (including school and university closures), case testing and symptomatic case isolation to reduce epidemic spread and burden on hospitals. Mitigation is intended to lessen an outbreak. However, the number of cases might still overwhelm health services 5 . Some jurisdictions have either preemptively or reactively adopted a combination of travel restrictions (shown to be effective in curtailing dispersion if implemented early enough 17,18 ) and suppression, which involves imposing complete shutdowns of the bulk of non-essential services for extended periods. Suppression strategies have led to marked decreases in new case rates in the short term by combining case isolation, quarantine, use of separate facilities for treating COVID-19 patients and large-scale

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“…Many serological enzyme-linked immunosorbent assays (ELISA) have been recently developed to detect anti-SARS-CoV-2 antibodies. However, these assays have four important limitations [4][5][6][7][8][9][10][11][12][13][14][15] . First, they lack the ability to detect antibodies at early stages of infection.…”

Section: Mainmentioning

confidence: 99%

Ultra-Sensitive High-Resolution Profiling of Anti-SARS-CoV-2 Antibodies for Detecting Early Seroconversion in COVID-19 Patients

Norman

Gilboa

Ogata

et al. 2020

Preprint

Self Cite

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The COVID-19 pandemic continues to infect millions of people worldwide. In order to curb its spread and reduce morbidity and mortality, it is essential to develop sensitive and quantitative methods that identify infected individuals and enable accurate population-wide screening of both past and present infection. Here we show that Single Molecule Array assays detect seroconversion in COVID-19 patients as soon as one day after symptom onset using less than a microliter of blood. This multiplexed assay format allows us to quantitate IgG, IgM and IgA immunoglobulins against four SARS-CoV-2 targets, thereby interrogating 12 antibody isotype-viral protein interactions to give a high resolution profile of the immune response. Using a cohort of samples collected prior to the outbreak as well as samples collected during the pandemic, we demonstrate a sensitivity of 86% and a specificity of 100% during the first week of infection, and 100% sensitivity and specificity thereafter. This assay should become the gold standard for COVID19 serological profiling and will be a valuable tool for answering important questions about the heterogeneity of clinical presentation seen in the ongoing pandemic.

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Serology characteristics of SARS-CoV-2 infection since the exposure and post symptoms onset

Cited by 87 publications

References 16 publications

Antibody tests in detecting SARS-CoV-2 infection: a meta-analysis

Antibody tests in detecting SARS-CoV-2 infection: a meta-analysis

Modeling shield immunity to reduce COVID-19 epidemic spread

Ultra-Sensitive High-Resolution Profiling of Anti-SARS-CoV-2 Antibodies for Detecting Early Seroconversion in COVID-19 Patients

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