• Jiufeng Sun, Xi Tang, Ru Bai, Chumin Liang, Lilian Zeng, Huifang Lin, Runyu Yuan, Pingping Zhou, Xuhe Huang, Qianlin Xiong, Jinju Peng, Fengfu Cui, Bixia Ke, Juan Su, Zhe Liu, Jing Lu, Junzhang Tian, Ruilin Sun, and Changwen Ke.
• Guangdong Provincial Institute of Public Health, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China.
• Clin. Microbiol. Infect. 2020 Dec 1; 26 (12): 1690.e1-1690.e4.

ObjectivesThe aim was to understand persistence of the virus in body fluids the and immune response of an infected host to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), an agent of coronavirus disease 2019 (COVID-19).MethodsWe determined the kinetics of viral load in several body fluids through real time reverse transcription polymerase chain reaction, serum antibodies of IgA, IgG and IgM by enzyme-linked immunosorbent assay and neutralizing antibodies by microneutralization assay in 35 COVID-19 cases from two hospitals in Guangdong, China.ResultsWe found higher viral loads and prolonged shedding of virus RNA in severe cases of COVID-19 in nasopharyngeal (1.3 × 106 vs 6.4 × 104, p < 0.05; 7∼8 weeks) and throat (6.9 × 106 vs 2.9 × 105, p < 0.05; 4∼5 weeks), but similar in sputum samples (5.5 × 106 vs 0.9 × 106, p < 0.05; 4∼5 weeks). Viraemia was rarely detected (2.8%, n = 1/35). We detected early seroconversion of IgA and IgG at the first week after illness onset (day 5, 5.7%, n = 2/35). Neutralizing antibodies were produced in the second week, and observed in all 35 included cases after the third week illness onset. The levels of neutralizing antibodies correlated with IgG (rs = 0.85, p < 0.05; kappa = 0.85) and IgA (rs = 0.64, p < 0.05; kappa = 0.61) in severe, but not mild cases (IgG, rs = 0.42, kappa = 0.33; IgA, rs = 0.32, kappa = 0.22). No correlation with IgM in either severe (rs = 0.17, kappa = 0.06) or mild cases (rs = 0.27, kappa = 0.15) was found.DiscussionWe revealed a prolonged shedding of virus RNA in the upper respiratory tract, and evaluated the consistency of production of IgG, IgA, IgM and neutralizing antibodies in COVID-19 cases.Copyright © 2020. Published by Elsevier Ltd.

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