Highlights d 8,558 IgG1 + antigen-binding clonotypes were identified by high-throughput scRNA/VDJ-seq d 14 potent SARS-CoV-2 neutralizing antibodies were found from 60 convalescent patients d BD-368-2 showed high therapeutic and prophylactic efficacy in SARS-CoV-2-infected mice d Neutralizing antibodies can be directly selected based on predicted CDR3 H structures

Dysfunctional immune response in the COVID-19 patients is a recurrent theme impacting symptoms and mortality, yet the detailed understanding of pertinent immune cells is not complete. We applied single-cell RNA sequencing to 284 samples from 196 COVID-19 patients and controls and created a comprehensive immune landscape with 1.46 million cells. The large dataset enabled us to identify that different peripheral immune subtype changes were associated with distinct clinical features including age, sex, severity, and disease stages of COVID-19. SARS-CoV-2 RNAs were found in diverse epithelial and immune cell types, accompanied by dramatic transcriptomic changes within viral positive cells. Systemic up-regulation of S100A8/A9, mainly by megakaryocytes and monocytes in the peripheral blood, may contribute to the cytokine storms frequently observed in severe patients. Our data provide a rich resource for understanding the pathogenesis and developing effective therapeutic strategies for COVID-19.

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