Persistence of SARS‐CoV‐2 nasopharyngeal swab PCR positivity in COVID‐19 convalescent plasma donors

Ikegami, Sachie; Benirschke, Robert; Flanagan, Tara; Tanna, Nicole; Klein, Tovah; Elue, Rita; Debosz, Patricia; Mallek, Jessica; Wright, Gregory; Guariglia, Perry; Kang, Jason; Gniadek, Thomas J.

BACKGROUND: Nucleic acid persists after symptom resolution and infectivity for many viral infections via delayed clearance of nucleic acid fragments, non‐infectious particles, or transmissible virus. For Coronavirus Disease 2019 (COVID‐19), the relationship between nasopharyngeal (NP) swab positivity, the development of antibodies against COVID‐19, and clinical history are unclear. STUDY DESIGN AND METHODS: Individuals who recovered from COVID‐19 and volunteered to donate convalescent plasma (CP) were screened by NP swab PCR, responded to a questionnaire, and were tested for anti‐COVID‐19 antibodies. RESULTS: A proportion of 11.8% of individuals tested positive for SARS‐CoV‐2 by NP swab PCR greater than 14 days after the resolution of symptoms of active disease, including one donor who had asymptomatic disease and tested positive by NP swab 41 days after her initial diagnosis. Clinical history did not show a significant correlation with persistence of NP swab positivity. Also, NP swab positivity >14 days from symptom resolution did not correlate with anti‐COVID‐19 serology results. IgG anti‐SARS‐CoV‐2 spike antibody strength correlated with hospitalization for COVID‐19 using two different assays. Total anti‐SARS‐CoV‐2 nucleocapsid antibody strength correlated with time from symptom resolution to sample collection and symptom duration. CONCLUSIONS: SARS‐CoV‐2 nucleic acid is detectable long after the resolution of symptoms in a significant percentage of previously diagnosed individuals, which is important to consider when interpreting PCR swab results. Persistence of PCR positivity does not correlate with antibody strength or symptoms of COVID‐19. If anti‐spike antibody is used to assess CP potency, individuals who suffered severe COVID‐19 disease symptoms may represent better donors.