Antibody seroconversion in asymptomatic and symptomatic patients infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)

Abstract

Objectives: Asymptomatic and symptomatic patients may transmit severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), but their clinical features and immune responses remain largely unclear. We aimed to characterise the clinical features and immune responses of asymptomatic and symptomatic patients infected with SARS‐CoV‐2. Methods: We collected clinical, laboratory and epidemiological records of patients hospitalised in a coronavirus field hospital in Wuhan. We performed qualitative detection of anti‐SARS‐CoV‐2 immunoglobulin M (IgM) and immunoglobulin G (IgG) using archived blood samples. Results: Of 214 patients with SARS‐CoV‐2, 26 (12%) were asymptomatic at hospital admission and during hospitalisation. Most asymptomatic patients were ≤ 60 years (96%) and females (65%) and had few comorbidities (< 16%). Serum levels of white and red blood cells were higher in asymptomatic than in symptomatic patients (P‐values < 0.05). During hospitalisation, IgG seroconversion was commonly observed in both asymptomatic and symptomatic patients (85% versus 94%, P‐value = 0.07); in contrast, IgM seroconversion was less common in asymptomatic than in symptomatic patients (31% versus 74%, P‐value < 0.001). The median time from the first virus‐positive screening to IgG or IgM seroconversion was significantly shorter in asymptomatic than in symptomatic patients (median: 7 versus 14 days, P‐value < 0.01). Furthermore, IgG/IgM seroconversion rates increased concomitantly with the clearance of SARS‐CoV‐2 in both asymptomatic and symptomatic patients. At the time of virus clearance, IgG/IgM titres and plasma neutralisation capacity were significantly lower in recovered asymptomatic than in recovered symptomatic patients (P‐values < 0.01). Conclusion: Asymptomatic and symptomatic patients exhibited different kinetics of IgG/IgM responses to SARS‐CoV‐2. Asymptomatic patients may transmit SARS‐CoV‐2, highlighting the importance of early diagnosis and treatment.