As the COVID-19 pandemic second wave is emerging, it is of the upmost importance to screen the population immunity in order to keep track of infected individuals. Consequently, SARS-CoV-2 immunoassays with high specificity and positive predictive values are needed to obtain an accurate epidemiological picture. As more data accumulate about the immune responses and the kinetics of neutralizing antibody (nAb) production in SARS-CoV-2 infected individuals, new applications are forecasted for serological assays such as nAb activity prediction in convalescent plasma from recovered patients. This multicenter study, involving six hospital centres, determined the baseline clinical performances, reproducibility and nAb level correlations of ten commercially available immunoassays. In addition, three lateral flow chromatography assays were evaluated as these devices can be used in logistically challenged area. All assays were evaluated using the same patient panels in duplicate thus enabling accurate comparison of the tests. Seven immunoassays examined in this study were shown to have excellent specificity (98 to 100%) and good to excellent positive predictive values (82 to 100%) when used in a low (5%) seroprevalence setting. We observed sensitivity values as low as 74% and as high as 95% at ≥15 days post symptom onset. The determination of optimized cut-off values through ROC curves analyses had a significant impact on the diagnostic resolution of several enzyme immunoassays by increasing the sensitivity significantly without a large trade-off in specificity. We found that Spike-based immunoassays seems to be better correlates of nAb activity. Finally, the results reported here will add up to the general knowledge of the inter-laboratory reproducibility of clinical performance parameters of immunoassays and provide new evidence about nAb activity prediction.

BACKGROUND: Serological assays designed to detect SARS-CoV-2 antibodies are being used in serological surveys and other specialized applications. As a result, and to ensure that the outcomes of serological testing meet high quality standards, evaluations are required to assess the performance of these assays and the proficiency of laboratories performing them. METHODS: A panel of 60 plasma/serum samples from blood donors who had Real Time-Polymerase Chain Reaction (RT-PCR) confirmed SARS-CoV-2 infections and 21 SARS-CoV-2 negative samples were secured and distributed to interested laboratories within Canada ( n = 30) and the United States ( n = 1). Participating laboratories were asked to provide details on the diagnostic assays used, the platforms the assays were performed on, and the results obtained for each panel sample. Laboratories were blinded with respect to the expected outcomes. RESULTS: The performance of the different assays evaluated was excellent, with the high-throughput platforms of Roche, Ortho, and Siemens demonstrating 100% sensitivity. Most other high-throughput platforms had sensitivities of >93%, with the exception of the IgG assay using the Abbott ARCHITECT which had an average sensitivity of only 87%. The majority of the high-throughput platforms also demonstrated very good specificities (>97%). CONCLUSION: This proficiency study demonstrates that most of the SARS-CoV-2 serological assays utilized by provincial public health or hospital laboratories in Canada have acceptable sensitivity and excellent specificity.