Temporal course of SARS-CoV-2 antibody positivity in patients with COVID-19 following the first clinical presentation

Abstract

Knowledge of the sensitivities of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibody tests beyond 35 days after the clinical onset of COVID-19 is insufficient. We aimed to describe positivity rate of SARS-CoV-2 assays employing three different measurement principles over a prolonged period. Two hundred sixty-eight samples from 180 symptomatic patients with COVID-19 and a reverse transcription polymerase chain reaction (RT-PCR) test followed by serological investigation of SARS-CoV-2 antibodies were included.. We conducted three chemiluminescence (including electrochemiluminscence, ECLIA), four enzyme linked immunosorbent assay (ELISA), and one lateral flow immunoassay (LFIA) test formats. Positivity rates, as well as positive (PPV) and negative predictive values (NPV) were calculated for each week after the first clinical presentation for COVID-19. Furthermore, combinations of tests were assessed within an orthogonal testing approach employing two independent assays and predictive values were calculated. Heat maps were constructed to graphically illustrate operational test characteristics. During a follow-up period of more than 9 weeks, chemiluminescence assays and one ELISA IgG test showed stable positivity rates after the third week. With the exception of ECLIA, the PPVs of the other chemiluminescence assays were ≥95% for COVID-19 only after the second week. ELISA and LFIA had somewhat lower PPVs. IgM exhibited insufficient predictive characteristics. An orthogonal testing approach provided PPVs ≥95% for patients with a moderate pretest probability (e.g., symptomatic patients), even for tests with a low single test performance. After the second week, NPVs of all but IgM assays were ≥95% for patients with low to moderate pretest probability. The confirmation of negative results using an orthogonal algorithm with another assay provided lower NPVs than the single assays. When interpreting results from SARS-CoV-2 tests, the pretest probability, time of blood draw and assay characteristics must be carefully considered. An orthogonal testing approach increases the accuracy of positive, but not negative, predictions.

Sex-specific differences in physiological parameters related to SARS-CoV-2 infections among a national cohort (COVI-GAPP study)

“…SARS-CoV-2 antibody tests were performed by the medical laboratory Dr Risch Ostschweiz AG (Buchs SG, Switzerland) with an orthogonal test algorithm employing electrochemiluminescence (ECLIA) assays testing for pan-immunoglobulins directed against the N antigen and the receptor binding domain (RBD) of the SARS-CoV-2 spike protein, as described by Risch et al [30]. The enacted procedure ensures testing for actual SARS-CoV-2 infection independent of vaccine status.…”

“…This is the Fig 1A and Fig 1B legend. Upon waking, participants synchronized the device with a complementary smartphone application and reported alcohol, medication, and drug intake (A) as well as potential COVID-19 symptoms (B) in the app.SARS-CoV-2 antibody testing and RT-PCR testingSARS-CoV-2 antibody tests were performed by the medical laboratory Dr Risch Ostschweiz AG (Buchs SG, Switzerland) with an orthogonal test algorithm employing electrochemiluminescence (ECLIA) assays testing for pan-immunoglobulins directed against the N antigen and the receptor binding domain (RBD) of the SARS-CoV-2 spike protein, as described by Risch et al[30]. The enacted procedure ensures testing for actual SARS-CoV-2 infection independent of vaccine status.…”