key: cord-0911475-743i6vp8
authors: Glans, H.; Gredmark-Russ, S.; Olausson, M.; Falck-Jones, S.; Varnaite, R.; Christ, W.; Maleki, K. T.; Lind Karlberg, M.; Broddesson, S.; Falck-Jones, R.; Bell, M.; Johansson, N.; Farnert, A.; Smed Sorensen, A.; Klingstrom, J.; Brave, A.
title: Shedding of infectious SARS-CoV-2 from airways in hospitalized COVID-19 patients in relation to serum antibody responses
date: 2020-09-13
journal: nan
DOI: 10.1101/2020.09.11.20191940
sha: fd042aded4c2868cc03ab50b3f9ce2087e91bcb5
doc_id: 911475
cord_uid: 743i6vp8

To understand the risk of transmission of SARS-CoV-2 in hospitalized COVID-19 patients we simultaneously assessed the presence of SARS-CoV-2 RNA, live infectious virus in the airways, and virus-specific IgG and neutralizing antibodies in sera in 36 hospitalized COVID-19 patients. SARS-CoV-2 could be cultured from four patients, all with low or undetectable antibody response. Our data suggests that the level of SARS-CoV-2 antibodies may correlate to risk for shedding live SARS-CoV-2 virus in hospitalized COVID-19 patients.

It is important to better understand the risk of severe acute respiratory syndrome coronavirus 2 30 (SARS-CoV-2) transmission from coronavirus disease 2019 patients. Many 31 studies report PCR-detectable SARS-CoV-2-RNA in the airways over time (1-3), but little has 32 been reported on shedding of infectious viruses from the airways in hospitalized COVID-19 at day 5 after onset of symptoms, had no detectable SARS-CoV-2-specific antibodies, but was 76 positive for infectious virus in the airways (data not shown). 77 There was a strong positive correlation between total SARS-CoV-2-specific IgG titers and 78 neutralizing antibody titers (Spearman's correlation: rs = 0.689, p < 0.001) ( Figure 1A ).

Patients sampled earlier after symptom onset, showed a variation in IgG titers and neutralizing 80 antibodies ( Figure 1B and (Table 2 and Table 3 ).

Viable SARS-CoV-2 were isolated from four patients. We could not detect viable SARS-CoV-90 2 virus from patients with SARS-CoV-2-specific IgG titers above 1:40, or with neutralizing 91 antibodies titers above 1:10. Seroconversion, with detectable neutralizing antibodies, was 92 observed in all 32 patients from whom no viable SARS-CoV-2 virus could be isolated from the 93 respiratory tract. In addition, no infectious virus could be isolated from the patients that were 94 SARS-CoV-2 RNA PCR negative.

In patients with a shorter symptom duration, there was a large variation in total specific IgG 96 and neutralizing antibody titers. Three of the culture-positive patients were sampled within 11 97 days after the onset of symptoms. However, the fourth patient with culturable SARS-CoV-2, 98 All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted September 13, 2020. mM L-glutamine, 20 mM HEPES) were then added. Cells were continuously monitored for 146 cytopathic effect (CPE). After 10 days the cultures were harvested and supernatants were 147 analyzed with RT-PCR specific for the SARS-CoV-2 E-gene and (rdrp)-gene (13). perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted September 13, 2020. All rights reserved. No reuse allowed without permission.

perpetuity.

preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in

The copyright holder for this this version posted September 13, 2020. . https://doi.org/10.1101/2020.09.11.20191940 doi: medRxiv preprint patients had prednisolone treatment before COVID-19 and had extra corticosteroids added as 262 treatment.

All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted September 13, 2020. . https://doi.org/10.1101/2020.09.11.20191940 doi: medRxiv preprint All rights reserved. No reuse allowed without permission.

perpetuity.

preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in

The copyright holder for this this version posted September 13, 2020. . https://doi.org/10.1101/2020.09.11.20191940 doi: medRxiv preprint Table 3 . SARS-CoV-2-specific antibody titers in relation to detectable SARS-CoV-2 RNA 281 and infectious SARS-CoV-2 in nasopharynx in all COVID-19 patients (n=36). perpetuity.

preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in

The copyright holder for this this version posted September 13, 2020. . 

SARS-CoV-2 Viral Load