Background: In the ongoing COVID-19 pandemic, there is an urgent need for comprehensive performance evaluation and clinical utility assessment of serological assays to understand the immune response to SARS-CoV-2. Methods: IgM/IgG and total antibodies against SARS-CoV-2 were measured by a cyclic enhanced fluorescence assay (CEFA) and a microsphere immunoassay (MIA), respectively. Independent performance evaluation included imprecision, reproducibility, specificity and cross-reactivity (CEFA n = 320, MIA n = 364). Clinical utility was evaluated by both methods in 87 patients at initial emergency department visit, 28 during subsequent hospitalizations (106 serial samples), and 145 convalescent patients. Totally 916 patients and 994 samples were evaluated. Results: Agreement of CEFA and MIA was 90.4%-94.5% (Kappa: 0.81-0.89) in 302 samples. CEFA and MIA detected SARS-CoV-2 antibodies in 26.2% and 26.3%, respectively, of ED patients. Detection rates increased over time reaching 100% after 21 days post-symptom onset. Longitudinal antibody kinetic changes by CEFA and MIA measurements correlated well and exhibited three types of seroconversion. Convalescent sera showed a wide range of antibody levels. Conclusion: Rigorously validated CEFA and MIA assays are reliable for detecting antibodies to SARS-CoV-2 and show promising clinical utility when evaluating immune response in hospitalized and convalescent patients, but are not useful for early screening at patient's initial ED visit. Respiratory Syndrome Coronavirus (SARS-CoV-2), the cause of COVID-19, is highly contagious and can result in significant mortality among susceptible individuals with comorbidities. Acute symptoms and signs of SARS-CoV-2 infection are highly nonspecific and include fever, cough, fatigue, myalgia, and dyspnea with some patients progressing to
Author contributionsMDC designed the study, collected the specimens, analyzed the data, and wrote the manuscript. LVV and SRB designed and supervised the study, and edited the manuscript. FNE collected the specimens and data. WST, MM, AB and SPS performed the autopsies and collected data. ZZ and HSY reviewed the data and edited the manuscript.
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