Silent SARS-CoV-2 Infections, Waning Immunity, Serology Testing, and COVID-19 Vaccination: A Perspective

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causes a spectrum of clinical manifestations, ranging from asymptomatic to mild, moderate, or severe illness with multi-organ failure and death. Using a new machine learning algorithm developed by us, we have reported a significantly higher number of predicted COVID-19 cases than the documented counts across the world. The sole reliance on confirmed symptomatic cases overlooking the symptomless COVID-19 infections and the dynamics of waning immunity may not provide ‘true’ spectrum of infection proportion, a key element for an effective planning and implementation of protection and prevention strategies. We and others have previously shown that strategic orthogonal testing and leveraging systematic data-driven modeling approach to account for asymptomatics and waning cases may situationally have a compelling role in informing efficient vaccination strategies beyond prevalence reporting. However, currently Centers for Disease Control and Prevention (CDC) does not recommend serological testing either before or after vaccination to assess immune status. Given the 27% occurrence of breakthrough infections in fully vaccinated (FV) group with many being asymptomatics and still a larger fraction of the general mass remaining unvaccinated, the relaxed mask mandate and distancing by CDC can drive resurgence. Thus, we believe it is a key time to focus on asymptomatics (no symptoms) and oligosymptomatics (so mild that the symptoms remain unrecognized) as they can be silent reservoirs to propagate the infection. This perspective thus highlights the need for proactive efforts to reevaluate the current variables/strategies in accounting for symptomless and waning fractions.

Translation suppression underlies the restrained COVID-19 mRNA vaccine response in the high-risk immunocompromised group

“…While 0 (0%) and 54 (6%) control subjects (HC & NT) had IgG Sp levels less than 50 AU/mL in the 2D and 3D Co-mV format experiments ( Figure S2 and Table 2A ). In particular, previous reports have shown that IgG Sp antibody titers of ≥ 4160 AU/mL correspond to a neutralizing titer ( 40 , 41 ) and here, we have found that 1 in 6 IC patients (16%) was able to generate neutralizing titers after 2 Co-mV doses compared to healthy controls (64%) ( Table 2B ). Although, the 3 rd dose improved the IgG response over neutralizing titer of 4160 AU/mL, despite 3 Co-mV doses, still over half the population (57%) in the immunocompromised SOT group had IgG response below the neutralizing titers ( Table 2B ).…”

The Pre-Vaccination Donated Blood Is Free from Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) but Is Rich with Anti-SARS-CoV-2 Antibodies: A Cross-Section Saudi Study

“…Although blood transfusion is an important part of the health care system, the adequate and safe availability of blood products to meet patients’ needs became a major concern during the COVID-19 pandemic [ 29 ]. Generally, it is believed that it is a key time to focus on asymptomatic (with no symptoms) and oligosymptomatic (with so mild symptoms that remain unrecognized) COVID-19 patients as they can be silent reservoirs to circulate SARS-CoV-2 infections [ 30 ].…”