Persisting Neutralizing Activity to SARS-CoV-2 over Months in Sera of COVID-19 Patients

Flehmig, Bertram; Schindler, Michael; Ruetalo, Natalia; Businger, Ramona; Bayer, Manfred; Haage, Angelika; Kirchner, Thomas; Klingel, Karin; Normann, Andrea; Pridzun, Lutz; Tougianidou, Despina; Ranke, Michael B.

The relationship between the nasopharyngeal virus load, IgA and IgG antibodies to both the S1-RBD-protein and the N-protein, as well as the neutralizing activity (NAbs) against SARS-CoV-2 in the blood of moderately afflicted COVID-19 patients, needs further longitudinal investigation. Several new serological methods to examine these parameters were developed, validated and applied in three patients of a family which underwent an ambulatory course of COVID-19 for six months. The virus load had almost completely disappeared after about four weeks. Serum IgA levels to the S1-RBD-protein and, to a lesser extent, to the N-protein, peaked about three weeks after clinical disease onset but declined soon thereafter. IgG levels rose continuously, reaching a plateau at approximately six weeks, and stayed elevated over the observation period. Virus-neutralizing activity reached a peak about 4 weeks after disease onset but dropped slowly. The longitudinal associations of virus neutralization and the serological immune response suggest immunity in patients even after a mild clinical course of COVID-19.