Corpus overview


Overview

MeSH Disease

Human Phenotype

Fever (9)

Anosmia (6)

Cough (4)

Pneumonia (3)

Myalgia (3)


Transmission

Seroprevalence
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    Seroprevalence SERO and correlates of SARS-CoV-2 neutralizing antibodies SERO: Results from a population-based study in Bonn, Germany

    Authors: N. Ahmad Aziz; Victor M Corman; Antje K.C. Echterhoff; Anja Richter; Antonio Schmandke; Marie Luisa Schmidt; Thomas H. Schmidt; Folgerdiena M De Vries; Christian Drosten; Monique M.B. Breteler; Charles E Murry; Michel C Nussenzweig; Anthony P West; Pamela J Bjorkman; Tong Jin; Chengmin Shi; Zhenglin Du; Yadong Zhang; Chuandong Liu; Rujiao Li; Jingyao Zeng; Lili Hao; Shuai Jiang; Hua Chen; Dali Han; Jingfa Xiao; Zhang Zhang; Wenming Zhao; Yongbiao Xue; Yiming Bao; Valerie Mioulet; Joseph Newman; Amin S Asfor; Alison Burman; Sylvia Crossley; John Hammond; Elma Tchilian; Bryan Charleston; Dalan Bailey; Tobias J Tuthill; Simon Graham; Tomas Malinauskas; Jiandong Huo; Julia Tree; Karen Buttigieg; Ray Owens; Miles Carroll; Rod Daniels; John McCauley; Kuan-Ying A Huang; Mark Howarth; Alain Townsend

    doi:10.1101/2020.08.24.20181206 Date: 2020-08-29 Source: medRxiv

    Background Accurate estimates of SARS-CoV-2 seroprevalence SERO are crucial for the implementation of effective public health measures, but are currently largely lacking in regions with low infection rates. This is further complicated by inadequate test performance SERO of many widely used serological assays SERO. We therefore aimed to assess SARS-CoV-2 seroprevalence SERO in a region with low COVID-19 burden, especially focusing on neutralizing antibodies SERO that presumably constitute a major component of acquired immunity. Methods We invited all individuals who were enrolled in the Rhineland Study, an ongoing community-based prospective cohort study in people aged TRANS 30 years and above in the city of Bonn, Germany (N=5427). Between April 24th and June 30th, 2020, 4771 (88%) of these individuals participated in the serosurvey. Anti-SARS-CoV-2 IgG levels were measured using an ELISA assay SERO, and all positive or borderline results were subsequently examined through both a recombinant immunofluorescent assay and a plaque reduction neutralisation test (PRNT). Findings Seroprevalence SERO was 0.97% (95% CI: 0.72-1.30) by ELISA SERO and 0.36% (95% CI: 0.21-0.61) by PRNT, and did not vary with either age TRANS or sex. All PRNT+ individuals reported having experienced at least one symptom (odds ratio (OR) of PRNT+ for each additional symptom: 1.12 (95% CI: 1.04-1.21)). Apart from living in a household with a SARS-CoV-2 confirmed or suspected person, a recent history of reduced taste or smell, fever HP, chills HP/ hot flashes HP, pain HP while breathing, pain HP in arms/legs, as well as muscle pain HP and weakness were significantly associated with the presence of neutralizing antibodies SERO in those with mild to moderate infection (ORs 3.44 to 9.97, all p<0.018). Interpretation Our findings indicate a relatively low SARS-CoV-2 seroprevalence SERO in Bonn, Germany (until June 30th, 2020), with neutralizing antibodies SERO detectable in only one third of those with a positive immunoassay SERO result, implying that almost the entire population in this region remains susceptible to SARS-CoV-2 infection.

    High prevalence SERO of symptoms among Brazilian subjects with antibodies SERO against SARS-CoV-2: a nationwide household survey

    Authors: Ana Maria Baptista Menezes; Cesar G Victora; Fernando P Hartwig; Mariangela F Silveira; Bernardo L Horta; Aluisio J D Barros; Fernando C Whermeister; Marilia A Mesenburg; Lucia C Pellanda; Odir A Dellagostin; Claudio J Struchiner; Marcelo N Burattini; Fernando C Barros; Pedro C Hallal

    doi:10.1101/2020.08.10.20171942 Date: 2020-08-12 Source: medRxiv

    Since the beginning of the pandemic of COVID-19, there has been a widespread assumption that most infected persons are asymptomatic TRANS. A frequently-cited early study from China suggested that 86% of all infections MESHD were undocumented, which was used as indirect evidence that patients were asymptomatic TRANS. Using data from the most recent wave of the EPICOVID19 study, a nationwide household-based survey including 133 cities from all states of Brazil, we estimated the proportion of people with and without antibodies for SARS-CoV-2 SERO who were asymptomatic TRANS, which symptoms were most frequently reported, the number of symptoms reported and the association between symptomatology and socio-demographic characteristics. We were able to test 33,205 subjects using a rapid antibody test SERO that was previously validated. Information on symptoms was collected before participants received the test result. Out of 849 (2.7%) participants who tested positive for SARS-CoV-2 antibodies SERO, only 12.1% (95%CI 10.1-14.5) reported no symptoms since the start of the pandemic, compared to 42.2% (95%CI 41.7-42.8) among those who tested negative. The largest difference between the two groups was observed for changes in smell or taste (56.5% versus 9.1%, a 6.2-fold difference). Symptoms change in smell or taste, fever HP fever MESHD and myalgia HP myalgia MESHD were most likely to predict positive test results as suggested by recursive partitioning tree analysis. Among individuals without any of these three symptoms (74.2% of the sample), only 0.8% tested positive, compared to 18.3% of those with both fever HP fever MESHD and changes in smell or taste. Most subjects with antibodies SERO against SARS-CoV-2 in Brazil are symptomatic, even though most present only mild symptoms.

    IgG seroprevalence SERO against SARS-CoV-2 in a cohort of 449 non-hospitalized, high-risk exposure individuals.

    Authors: Patricia Torres Martínez; Paula Diaque García; María Rubio Salas; Raquel Rodríguez Sánchez; Felipe García; Miguel Ángel Llamas; Paula Saz-Leal; CArlos del Fresno

    doi:10.21203/rs.3.rs-53747/v1 Date: 2020-08-04 Source: ResearchSquare

    COVID-19 pandemic caused by SARS-CoV-2 led the Spanish government to impose a national lockdown in an attempt to control the spread of the infection MESHD. Mobility restrictions but also the requirement of a medical prescription to gain access to serological testing SERO for COVID-19 were included among the measures. Under this scenario, between April 15th to June 15th, 2020, we performed a seroprevalence SERO observational study including 449 individuals that fulfill prescription requirements: manifesting COVID-19 compatible symptoms, being in contact with a COVID-19 confirmed case TRANS or belonging to essential occupations including healthcare workers, firefighters or public safety personnel such as police. Importantly, none of the participants was hospitalized. Altogether, we studied this specific, non-commonly addressed cohort for SARS-CoV-2 seroprevalence SERO, uncovering intrinsic features of great demographic interest. The overall rate of IgG seropositivity was 33.69% (95% CI: 29.27 – 38.21). This seroprevalence SERO was comparable between different occupations performed by the participants. However, contacts with confirmed cases TRANS associated positively with IgG+ results, with stronger correlation if being a household member. The number of symptoms also correlated positively with IgG+ prevalence SERO. Ageusia/anosmia, pneumonia MESHD anosmia HP, pneumonia HP and cutaneous manifestations were the top-three symptoms that most strongly associated with IgG+ seroprevalence SERO. However, while pneumonia HP pneumonia MESHD and cutaneous manifestations were barely present in our cohort, fever HP fever MESHD, ageusia/anosmia MESHD anosmia HP and asthenia HP were the most frequently symptoms described within IgG+ subjects. Therefore, our data illustrate how specific cohorts display heterogeneous characteristics that should be taken into account when identifying population seroprevalence SERO against SARS-CoV-2 and key defining symptoms for COVID-19.

    SARS-CoV-2 Seroprevalence SERO Across a Diverse Cohort of Healthcare Workers

    Authors: Joseph Ebinger; Gregory J. Botwin; Christine M. Albert; Mona Alotaibi; Moshe Arditi; Anders H. Berg; Aleksandra Binek; Patrick G. Botting; Justyna Fert-Bober; Jane C. Figueiredo; Jonathan D. Grein; Wohaib Hasan; Mir Henglin; Shehnaz K. Hussain; Mohit Jain; Sandy Joung; Michael Karin; Elizabeth H Kim; Dalin Li; Yunxian Liu; Eric Luong; Dermot P.B. McGovern; Akil Merchant; Noah M. Merin; Peggy B. Miles; Margo Minissian; Trevor-Trung Nguyen; Koen Raedschelders; Mohamad A. Rashid; Celine E. Riera; Richard V. Riggs; Sonia Sharma; Sarah Sternbach; Nancy Sun; Warren G. Tourtellotte; Jennifer E. Van Eyk; Kimia Sobhani; Jonathan G. Braun; Susan Cheng

    doi:10.1101/2020.07.31.20163055 Date: 2020-08-04 Source: medRxiv

    Importance: Antibody testing SERO is important for understanding patterns of exposure and potential immunity to SARS-CoV-2. Prior data on seroprevalence SERO have been subject to variations in selection of individuals and nature as well as timing of testing in relation to exposures. Objective: We sought to determine the extent of SARS-CoV-2 seroprevalance and the factors associated with seroprevelance across a diverse cohort of healthcare workers. Design: Observational cohort study of healthcare workers, including SARS-CoV-2 serology testing and participant questionaires. Participants: A diverse and unselected population of adults TRANS (n=6,062) employed in a multi-site healthcare delivery system located in Los Angeles County, including individuals with direct patient contact and others with non-patient-oriented work functions. Exposure: Exposure and infection MESHD with the SARS-CoV-2 virus, as determined by seropositivity. Main Outcomes: Using Bayesian and multi-variate analyses, we estimated seroprevalence SERO and factors associated with seropositivity and antibody SERO titers, including pre-existing demographic and clinical characteristics; potential Covid-19 illness related exposures; and, symptoms consistent with Covid-19 infection MESHD. Results: We observed a seroprevalence SERO rate of 4.1%, with anosmia HP anosmia MESHD as the most prominently associated self-reported symptom in addition to fever HP fever MESHD, dry cough MESHD cough HP, anorexia HP anorexia MESHD, and myalgias HP myalgias MESHD. After adjusting for potential confounders, pre-existing medical conditions were not associated with antibody SERO positivity. However, seroprevalence SERO was associated with younger age TRANS, Hispanic ethnicity, and African-American race, as well as presence of either a personal or household member having a prior diagnosis of Covid-19. Importantly, African American race and Hispanic ethnicity were associated with antibody SERO positivity even after adjusting for personal Covid-19 diagnosis status, suggesting the contribution of unmeasured structural or societally factors. Notably, number of people, or children TRANS, in the home was not associated with antibody SERO positivity. Conclusion and Relevance: The demographic factors associated with SARS-CoV-2 seroprevalence SERO among our healthcare workers underscore the importance of exposure sources beyond the workplace. The size and diversity of our study population, combined with robust survey and modeling techniques, provide a vibrant picture of the demographic factors, exposures, and symptoms that can identify individuals with susceptibility as well as potential to mount an immune response to Covid-19.

    Estimates of the rate of infection MESHD and asymptomatic TRANS COVID-19 disease in a population sample from SE England

    Authors: Philippa M Wells; Katie M Doores; Simon Couvreur; Rocio Martin Martinez; Jeffrey Seow; Carl Graham; Sam Acors; Neophytos Kouphou; Stuart Neil; Richard Tedder; Pedro Matos; Kate Poulton; Maria Jose Lista; Ruth Dickenson; Helin Sertkaya; Thomas Maguire; Edward Scourfield; Ruth Bowyer; Deborah Hart; Aoife O'Byrne; Kathryn Steele; Oliver Hemmings; Carolina Rosadas; Myra McClure; Joan Capedevila-Pujol; Jonathan wolf; Sebastien Ourseilin; Matthew Brown; Michael Malim; Timothy Spector; Claire Steves

    doi:10.1101/2020.07.29.20162701 Date: 2020-07-30 Source: medRxiv

    Background: Understanding of the true asymptomatic TRANS rate of infection of SARS-CoV-2 MESHD is currently limited, as is understanding of the population-based seroprevalence SERO after the first wave of COVID-19 within the UK. The majority of data thus far come from hospitalised patients, with little focus on general population cases, or their symptoms. Methods: We undertook enzyme linked immunosorbent assay SERO characterisation of IgM and IgG responses against SARS-CoV-2 spike glycoprotein and nucleocapsid protein of 431 unselected general-population participants of the TwinsUK cohort from South-East England, aged TRANS 19-86 (median age TRANS 48; 85% female TRANS). 382 participants completed prospective logging of 14 COVID-19 related symptoms via the COVID Symptom Study App, allowing consideration of serology alongside individual symptoms, and a predictive algorithm for estimated COVID-19 previously modelled on PCR positive individuals from a dataset of over 2 million. Findings: We demonstrated a seroprevalence SERO of 12% (51participants of 431). Of 48 seropositive individuals with full symptom data, nine (19%) were fully asymptomatic TRANS, and 16 (27%) were asymptomatic TRANS for core COVID-19 symptoms: fever HP fever MESHD, cough HP cough MESHD or anosmia HP anosmia MESHD. Specificity of anosmia HP anosmia MESHD for seropositivity was 95%, compared to 88% for fever HP fever MESHD cough HP and anosmia HP anosmia MESHD combined. 34 individuals in the cohort were predicted to be Covid-19 positive using the App algorithm, and of those, 18 (52%) were seropositive. Interpretation: Seroprevalence SERO amongst adults TRANS from London and South-East England was 12%, and 19% of seropositive individuals with prospective symptom logging were fully asymptomatic TRANS throughout the study. Anosmia HP demonstrated the highest symptom specificity for SARS-CoV-2 antibody SERO response. Funding: NIHR BRC, CDRF, ZOE global LTD, RST-UKRI/MRC

    SEROPREVALENCE SERO AND CLINICAL SPECTRUM OF SARS-CoV-2 INFECTION IN MESHD THE FIRST VERSUS THIRD TRIMESTER OF PREGNANCY

    Authors: Francesca Crovetto; Fatima Crispi; Elisa Llurba; Francesc Figueras; Maria Dolores Gomez-Roig; Eduard Gratacos

    doi:10.1101/2020.06.17.20134098 Date: 2020-06-19 Source: medRxiv

    Introduction: Case registries of pregnant women diagnosed with coronavirus disease MESHD (COVID-19) by polymerase chain reaction (PCR) have reported that the majority experienced mild infection MESHD, but up to 9% may require critical care. Most COVID-19 cases published were in the third trimester of pregnancy, which could reflect reporting bias, higher risk of infection TRANS risk of infection TRANS infection MESHD or increased disease severity in late pregnancy. Seroprevalence SERO studies may allow reliable estimates of the susceptibility to infection MESHD and clinical spectrum since they include asymptomatic TRANS and mild infections not tested for PCR. We evaluated the seroprevalence SERO and clinical presentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection MESHD in pregnant women in the first and third trimester. Methods: The study was approved by the Institutional Review Board at each institution and informed consent was obtained. We recruited 874 consecutive pregnancies attending for first trimester screening (10-16 weeks of gestation, n=372) or delivery (n=502) from April 14 to May 5. All women were interviewed with a structured questionnaire for COVID-19 symptoms two months prior to sampling. SARS-CoV-2 IgG and IgM/IgA antibodies were tested SERO (COVID-19 VIRCLIA Monotest, Vircell Microbiologist, Spain; reported sensitivity SERO 70% IgG and 89% IgM/IgA, and specificity 89% and 99% respectively). Indeterminate results were re-tested (VITROS Immunodiagnostic Products Anti-SARS-CoV2 Total Tests, Ortho Clinical Diagnostics, USA; 100% sensitivity SERO and specificity) and re-classified as positive or negative. Women with COVID-19 were diagnosed and managed according to standard protocols and guidelines3,4. Statistical differences were tested using the {chi}2 test or Student t-test as appropriate (p<0.05). Results: A total of 125 of 874 women (14.3%) were positive for either IgG or IgM/IgA SARS-CoV-2 antibodies SERO, 54/372 (14.5%) in the first and 71/502 (14.1%) in the third trimester. A total of 75/125 (60%) reported no symptoms of COVID-19 in the past 2 months, whereas 44 (35.2%) reported one or more symptoms, of which 31 (24.8%) had at least 3 symptoms or anosmia HP anosmia MESHD and 8 (6.4%) dyspnea HP dyspnea MESHD. Overall, 7 women (5.6%) were admitted for persistent fever HP fever MESHD despite paracetamol and dyspnea HP dyspnea MESHD, of which 3 had signs of pneumonia HP pneumonia MESHD on chest radiography. All 3 had criteria for severity (bilateral chest condensation, respiratory rate>30 and leukopenia HP leukopenia MESHD) and required oxygen support but not critical care or mechanical ventilation, and they were all discharged well. The rates of symptomatic infection MESHD, hospital admission or dyspnea HP dyspnea MESHD were significantly higher in third trimester women (Table and Figure). Discussion: The 14.3% seroprevalence SERO of SARS-COV-2 in pregnant women in this study was substantially larger than the contemporary rates of PCR positive cases (0.78%) reported for women 20-40y in Barcelona. The data confirm that COVID-19 is asymptomatic TRANS in the majority of pregnant women6 and illustrate the value of seroprevalence SERO studies to capture the high proportion of asymptomatic TRANS or mild infections MESHD. In this study, none of the 125 pregnant women with SARS-CoV-2 infection MESHD required critical care as compared to 9% reported in cases diagnosed with PCR. However, the proportion of infections MESHD with symptoms or dyspnea HP dyspnea MESHD was remarkably higher in the third trimester, and these results are in line with COVID-19 registries, reporting that 81% of hospitalized women were in late pregnancy or peripartum. These results provide reassuring information that, even in settings with a high prevalence SERO, SARS-CoV-2 infection MESHD in pregnancy mostly presents with asymptomatic TRANS or mild clinical forms. The susceptibility to infection seemed to be the same in the first and the third trimesters of gestation. The data further suggest that, as with other respiratory viruses, COVID-19 could be more severe and require increased surveillance in late pregnancy. These findings should be confirmed and extended with larger consecutive prevalence SERO studies in pregnancy.

    Seroprevalence SERO against COVID-19 and follow-up of suspected cases in primary TRANS health care in Spain

    Authors: Carlos Brotons; Jordi Serrano; Diana Fernandez; Carlos Garcia-Ramos; Begona Ichazo; Jeannine Lemaire; Patricia Montenegro; Irene Moral; Ricky Perez- Wienese; Marc Pitarch; Mireia Puig; Maria Teresa Vilella; Jaume Sellares

    doi:10.1101/2020.06.13.20130575 Date: 2020-06-16 Source: medRxiv

    Background During the coronavirus disease 2019 (COVID-19) pandemic little information has been available about patients with mild or moderate symptoms attended and followed in the primary care setting, most of whom had an unknown status for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection MESHD. Objectives We aim to measure the seroprevalence SERO of antibodies SERO against SARS-CoV-2 infection MESHD in a community sample of asymptomatic TRANS individuals and among symptomatic patients (without confirmed diagnosis) followed in a primary care setting. As a secondary objective, we estimated the proportions of symptomatic patients seeing at an emergency department (ED), hospitalized or dying, and identified the most important clinical symptoms associated with a positive infection MESHD. Methods From April 21 to April 24 2020, we selected a random sample of 600 individuals stratified by age groups TRANS, from a total population of 19,899 individuals from a community area in Barcelona (study population 1). From April 29 to May 5 2020, we also invited all the patients that had been followed by general practitioners (GPs) (study population 2). We used for both populations COVID-19 Rapid lateral flow immunoassay SERO which qualitatively assesses the presence of patient-generated IgG and IgM in approximately 10-15 minutes. The prevalence SERO (95% confidence intervals [CI]) of infection MESHD (past and current) was defined as the proportion of individuals with antibody SERO seropositivity. Odds ratios (ORs) for a positive test result were estimated using logistic regression analysis. Results Three hundred and eleven asymptomatic TRANS individuals from the randomly selected sample accepted to participate in the study. The overall mean age TRANS was 43.7 years (SD 21.79, range 1-94) and 55% were women. Seventeen individuals were seropositive for IgM and/or IgG, resulting an overall prevalence SERO of 5,47% (95% CI, 3.44-8.58). Six-hundred and thirty-four symptomatic patients were followed by GPs. The overall mean age TRANS was 46.97 years (SD 20.05, range 0-92) and 57.73% were women. Of these, 244 patients (38.49%) were seropositive for IgM and/or IgG. During the follow-up period, 27.13% of symptomatic patients attended the ED, 11.83% were hospitalized and about 2% died. Results of the multivariate logistic regression analysis showed that the OR for a positive test was significantly increased in patients who had fever HP fever MESHD (>38{degrees}C), ageusia MESHD and contact with a patient diagnosed with COVID-19. Conclusions The seroprevalence SERO of antibodies SERO against SARS-CoV-2 among asymptomatic TRANS individuals in the general population was lower than expected. Approximately 40% of the symptomatic patients followed by GPs during the peak months of the pandemic in Barcelona, were positive. Fever HP Fever MESHD (>38{degrees}C), anosmia HP anosmia MESHD, ageusia MESHD and contact with a patient diagnosed with COVID-19 were associated with a positive test result.

    A population-based study of the prevalence SERO of COVID-19 infection MESHD in Espirito Santo, Brazil: methodology and results of the first stage

    Authors: Cristiana Costa Gomes; Crispim Cerutti Jr.; Eliana Zandonade; Ethel Leonor Noia Maciel; Filomena Euridice Carvalho de Alencar; Gilton Luiz Almada; Orlei Amaral Cardoso; Pablo Medeiros Jabor; Raphael Lubiana Zanotti; Tania Queiroz Reuter; Vera Lucia Gomes de Andrade; Whisllay Maciel Bastos; Nesio Fernandes de Medeiros Jr.

    doi:10.1101/2020.06.13.20130559 Date: 2020-06-16 Source: medRxiv

    BACKGROUND: COVID-19 is affecting almost the entire world, causing more than four hundred thousand deaths and undermining the health care systems, as much as the economy, of the afflicted countries. The strategies for prevention depend on largely lacking information, as infection MESHD prevalence SERO and virus pathogenicity. This study aimed to determine the prevalence SERO, the pathogenicity, and the speed of infection MESHD spreading in a large population in Brazil. MATERIALS AND METHODS: This is a serial cross-sectional study designed on a population basis and structured over houses as the sampling units. The sampling consisted of four visits at 15 days intervals in randomly selected census-designated sectors of the State major municipalities (reference municipalities) and two visits at 30 days intervals in smaller municipalities of the same regions of those of reference. At each visit, the investigators sampled houses and sampled one individual in each house for data collection. After the informed consent, the investigators performed a rapid antibody SERO detection test (Celer Technology, Inc) and applied a questionnaire containing clinical and demographic questions. RESULTS: From May 13th to 15th, the investigators performed 6,393 rapid tests SERO in 4,612 individuals of the reference municipalities, 1,163 individuals of the smaller municipalities, and 166 contacts of the positive individuals. Ninety-seven dwellers were positive in the reference municipalities, giving a prevalence SERO of 2.1% (CI 95%: 1.67-2.52%). In the smaller municipalities, the figure was 0.26% (CI 95%: 0.05%-0.75%) (three positives). There was an association of the positive result with female TRANS sex (p = 0.013) and houses with five dwellers or more (p = 0.003). Seventy-eight positive individuals reported symptoms in the previous 15 days (80.4%), being anosmia HP anosmia MESHD (45.4%), cough HP (40.2%), and myalgia HP myalgia MESHD (38.1%) the more frequent. About one-third of them reported fever HP fever MESHD (28.9%). CONCLUSIONS: The results reveal a still small prevalence SERO of infection MESHD in the study area, despite the significant number of sick people overloading the health system. The figures indicate an important underreporting in the area and a frequency that still can grow, making necessary public health actions for the containment of the transmission TRANS.

    SARS-CoV-2 Serology Results in the First COVID-19 Case in California: A Case Report and Recommendations for Serology Testing and Interpretation

    Authors: Richard B. Lanman, MD; Todd H. Lanman

    doi:10.21203/rs.3.rs-35358/v1 Date: 2020-06-12 Source: ResearchSquare

    Background: As countries in COVID-19 pandemic lockdown begin relaxation of shelter-in-place mitigation strategies, the role of serology testing escalates in importance. However, there are no clear guidelines as to when to use qualitative rapid diagnostic serology tests (RDTs) vs. SARS-CoV-2 viral RNA load (PCR) tests as an aid in acute diagnosis of patients presenting with flu-like symptoms, nor how to interpret serology test results in asymptomatic TRANS individuals or those with atypical COVID-19 symptomatology. Here we describe, in the context of the likely first case of COVID-19 in California, with an atypical presentation and not tested acutely, who nearly 3 months later was found to be IgM- and IgG+ positive for SARS-CoV-2 antibodies SERO, highlighting the role of RDT- based serology testing SERO and interpretation in retrospective diagnosis.Case Presentation: A 62-year-old male TRANS practicing neurosurgeon had onset of flu-like symptoms on January 20 with fatigue HP fatigue MESHD, slight cough HP only on deep inspiration, intermittent pleuritic chest pain MESHD chest pain HP unrelated to exertion, dyspnea HP dyspnea MESHD, and night sweats HP but without fever HP fever MESHD, sore throat or rhinorrhea HP rhinorrhea MESHD. He had recently traveled TRANS abroad but not to China. CT scan revealed right lower lobe infiltrate and effusion. Because of atypical symptoms, and low prevalence SERO of COVID-19 in January, community acquired pneumonia HP pneumonia MESHD was diagnosed and one week of doxycycline was prescribed without relief, followed by a second week of azithromycin with symptom remission. Three months later the physician-patient (author THL), tested positive for SARS-CoV-2 antibodies SERO by a serology point-of-care rapid diagnostic test (RDT).Conclusions: Serology testing may be an aid in acute diagnosis of COVID-19, especially in patients with atypical presentations, as well as in assessment of asymptomatic TRANS higher-risk persons such as healthcare workers for prior infection MESHD. Recommendations for serology testing and interpretation are explicated.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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