Epidemiologic, immunologic, and virus characteristics in patients with paired SARS-CoV-2 serology and reverse transcription polymerase chain reaction testing

Shragai, Talya; Smith-Jeffcoat, Sarah E; Koh, Mitsuki; Schechter, Marcos C; Rebolledo, Paulina A; Kasinathan, Vyjayanti; Wang, Yun; Hoffman, Adam; Miller, Halie; Tejada-Strop, Alexandra; Jain, Shilpi; Tamin, Azaibi; Harcourt, Jennifer L; Thornburg, Natalie J; Wong, Phili; Medrzycki, Magdalena; Folster, Jennifer M; Semenova, Vera; Steward-Clark, Evelene; Drobenuic, Jan; Biedron, Caitlin; Stewart, Rebekah J; da Silva, Juliana; Kirking, Hannah L; Tate, Jacqueline E

BACKGROUND: The natural history and clinical progression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections can be better understood using combined serological and reverse transcription polymerase chain reaction (RT-PCR) testing. METHODS: Nasopharyngeal swabs and serum were collected at a single time-point from patients at an urban, public hospital August - November 2020 and tested for SARS-CoV-2 using RT-PCR, viral culture, and anti-Spike pan-Ig antibody testing. Participant demographics and symptoms were collected through interview. Chi-squared and Fisher's exact tests were used to identify associations between RT-PCR and serology results with presence of viable virus and frequency of symptoms. RESULTS: Among 592 participants, 129 (21.8%) had evidence of SARS-CoV-2 infection by RT-PCR or serology. Presence of SARS-CoV-2 antibodies was strongly associated with lack of viable virus (p-value=0.016). COVID-19 symptom frequency was similar for patients testing RT-PCR positive/seronegative and patients testing RT-PCR positive/seropositive. Patients testing RT-PCR positive/seronegative reported headaches, fatigue, diarrhea and vomiting at rates not statistically significantly different from those testing RT-PCR negative/seropositive. CONCLUSIONS: While patients testing SARS-CoV-2 seropositive were unlikely to test positive for viable virus and were therefore low-risk for forward transmission, COVID-19 symptoms were common. Paired SARS-CoV-2 RT-PCR and antibody testing provides more nuanced understanding of patients' COVID-19 status.