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Liu AB, Lee D, Jalihal AP, Hanage WP, Springer M. Quantitatively assessing early detection strategies for mitigating COVID-19 and future pandemics. Nat Commun 2023; 14:8479. [PMID: 38123536 PMCID: PMC10733317 DOI: 10.1038/s41467-023-44199-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Researchers and policymakers have proposed systems to detect novel pathogens earlier than existing surveillance systems by monitoring samples from hospital patients, wastewater, and air travel, in order to mitigate future pandemics. How much benefit would such systems offer? We developed, empirically validated, and mathematically characterized a quantitative model that simulates disease spread and detection time for any given disease and detection system. We find that hospital monitoring could have detected COVID-19 in Wuhan 0.4 weeks earlier than it was actually discovered, at 2,300 cases (standard error: 76 cases) compared to 3,400 (standard error: 161 cases). Wastewater monitoring would not have accelerated COVID-19 detection in Wuhan, but provides benefit in smaller catchments and for asymptomatic or long-incubation diseases like polio or HIV/AIDS. Air travel monitoring does not accelerate outbreak detection in most scenarios we evaluated. In sum, early detection systems can substantially mitigate some future pandemics, but would not have changed the course of COVID-19.
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Affiliation(s)
- Andrew Bo Liu
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA.
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
| | - Daniel Lee
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - William P Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michael Springer
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA.
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2
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Liu AB, Lee D, Jalihal AP, Hanage WP, Springer M. Quantitatively assessing early detection strategies for mitigating COVID-19 and future pandemics. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.08.23291050. [PMID: 37398047 PMCID: PMC10312821 DOI: 10.1101/2023.06.08.23291050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Researchers and policymakers have proposed systems to detect novel pathogens earlier than existing surveillance systems by monitoring samples from hospital patients, wastewater, and air travel, in order to mitigate future pandemics. How much benefit would such systems offer? We developed, empirically validated, and mathematically characterized a quantitative model that simulates disease spread and detection time for any given disease and detection system. We find that hospital monitoring could have detected COVID-19 in Wuhan 0.4 weeks earlier than it was actually discovered, at 2,300 cases (standard error: 76 cases) compared to 3,400 (standard error: 161 cases). Wastewater monitoring would not have accelerated COVID-19 detection in Wuhan, but provides benefit in smaller catchments and for asymptomatic or long-incubation diseases like polio or HIV/AIDS. Monitoring of air travel provides little benefit in most scenarios we evaluated. In sum, early detection systems can substantially mitigate some future pandemics, but would not have changed the course of COVID-19.
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Affiliation(s)
- Andrew Bo Liu
- Department of Systems Biology, Harvard Medical School; Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School; Boston, MA, USA
| | - Daniel Lee
- Department of Biomedical Informatics, Harvard Medical School; Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard; Cambridge, MA, USA
| | | | - William P. Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health; Boston, MA, USA
| | - Michael Springer
- Department of Systems Biology, Harvard Medical School; Boston, MA, USA
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3
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L Mandel H, Colleen G, Abedian S, Ammar N, Charles Bailey L, Bennett TD, Daniel Brannock M, Brosnahan SB, Chen Y, Chute CG, Divers J, Evans MD, Haendel M, Hall MA, Hirabayashi K, Hornig M, Katz SD, Krieger AC, Loomba J, Lorman V, Mazzotti DR, McMurry J, Moffitt RA, Pajor NM, Pfaff E, Radwell J, Razzaghi H, Redline S, Seibert E, Sekar A, Sharma S, Thaweethai T, Weiner MG, Jae Yoo Y, Zhou A, Thorpe LE. Risk of post-acute sequelae of SARS-CoV-2 infection associated with pre-coronavirus disease obstructive sleep apnea diagnoses: an electronic health record-based analysis from the RECOVER initiative. Sleep 2023; 46:zsad126. [PMID: 37166330 PMCID: PMC10485569 DOI: 10.1093/sleep/zsad126] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/20/2023] [Indexed: 05/12/2023] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) has been associated with more severe acute coronavirus disease-2019 (COVID-19) outcomes. We assessed OSA as a potential risk factor for Post-Acute Sequelae of SARS-CoV-2 (PASC). METHODS We assessed the impact of preexisting OSA on the risk for probable PASC in adults and children using electronic health record data from multiple research networks. Three research networks within the REsearching COVID to Enhance Recovery initiative (PCORnet Adult, PCORnet Pediatric, and the National COVID Cohort Collaborative [N3C]) employed a harmonized analytic approach to examine the risk of probable PASC in COVID-19-positive patients with and without a diagnosis of OSA prior to pandemic onset. Unadjusted odds ratios (ORs) were calculated as well as ORs adjusted for age group, sex, race/ethnicity, hospitalization status, obesity, and preexisting comorbidities. RESULTS Across networks, the unadjusted OR for probable PASC associated with a preexisting OSA diagnosis in adults and children ranged from 1.41 to 3.93. Adjusted analyses found an attenuated association that remained significant among adults only. Multiple sensitivity analyses with expanded inclusion criteria and covariates yielded results consistent with the primary analysis. CONCLUSIONS Adults with preexisting OSA were found to have significantly elevated odds of probable PASC. This finding was consistent across data sources, approaches for identifying COVID-19-positive patients, and definitions of PASC. Patients with OSA may be at elevated risk for PASC after SARS-CoV-2 infection and should be monitored for post-acute sequelae.
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Affiliation(s)
- Hannah L Mandel
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Gunnar Colleen
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Sajjad Abedian
- Information Technologies and Services Department, Weill Cornell Medicine, New York, NY, USA
| | - Nariman Ammar
- Department of Pediatrics, University of Tennessee Health Science Center College of Medicine Memphis, Memphis, TN, USA
| | - L Charles Bailey
- Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tellen D Bennett
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA
| | | | - Shari B Brosnahan
- Division of Pulmonary, Department of Medicine, Critical Care and Sleep Medicine, NYU Langone Health, New York, NY, USA¸
| | - Yu Chen
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Christopher G Chute
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jasmin Divers
- Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, NY, USA
| | - Michael D Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Melissa Haendel
- Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Margaret A Hall
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Kathryn Hirabayashi
- Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mady Hornig
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Stuart D Katz
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Ana C Krieger
- Departments of Medicine, Neurology, and Genetic Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Johanna Loomba
- Integrated Translational Health Research Institute, University of Virginia, Charlottesville, VA, USA
| | - Vitaly Lorman
- Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diego R Mazzotti
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Julie McMurry
- Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard A Moffitt
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Nathan M Pajor
- Division of Pulmonary Medicine Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily Pfaff
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jeff Radwell
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Hanieh Razzaghi
- Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | - Suchetha Sharma
- Integrated Translational Health Research Institute, University of Virginia, Charlottesville, VA, USA
| | - Tanayott Thaweethai
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Mark G Weiner
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Yun Jae Yoo
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Andrea Zhou
- Integrated Translational Health Research Institute, University of Virginia, Charlottesville, VA, USA
| | - Lorna E Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Filgueiras PS, Corsini CA, Almeida NBF, Pedrosa MLC, Miranda DAPD, Gomes SVC, Assis JVD, Silva RA, Medeiros MIVDARCD, Lourenço AJ, Bicalho CMF, Vilela RVR, Jeremias WDJ, Fernandes GDR, Queiroz RFGE. Rapid antigen test as a tool for the identification of SARS-CoV-2 infection and its potential as a self-testing device. Rev Soc Bras Med Trop 2023; 56:e01672022. [PMID: 37222349 DOI: 10.1590/0037-8682-0167-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 03/01/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND SARS-CoV-2 virus originated in Wuhan (China) in December (2019) and quickly spread worldwide. Antigen tests are rapid diagnostic tests (RDT) that produce results in 15-30 min and are an important tool for the scale-up of COVID-19 testing. COVID-19 diagnostic tests are authorized for self-testing at home in some countries, including Brazil. Widespread COVID-19 diagnostic testing is required to guide public health policies and control the speed of transmission and economic recovery. METHODS Patients with suspected COVID-19 were recruited at the Hospital da Baleia (Belo Horizonte, Brazil). The SARS-CoV-2 antigen-detecting rapid diagnostic tests were evaluated from June 2020 to June 2021 using saliva, nasal, and nasopharyngeal swab samples from 609 patients. Patient samples were simultaneously tested using a molecular assay (RT-qPCR). Sensitivity, specificity, accuracy, and positive and negative predictive values were determined using the statistical program, MedCalc, and GraphPad Prism 8.0. RESULTS The antigen-detecting rapid diagnostic tests displayed 98% specificity, 60% sensitivity, 96% positive predictive value, and moderate concordance with RT-qPCR. Substantial agreement was found between the two methods for patients tested < 7 days of symptom onset. CONCLUSIONS Our findings support the use of Ag-RDT as a valuable and safe diagnostic method. Ag-RDT was also demonstrated to be an important triage tool for suspected COVID-19 patients in emergencies. Overall, Ag-RDT is an effective strategy for reducing the spread of SARS-CoV-2 and contributing to COVID-19 control.
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Affiliation(s)
- Priscilla Soares Filgueiras
- Fundação Oswaldo Cruz, Instituto René Rachou, Diagnóstico e Terapia de Doenças Infecciosas e Câncer, Belo Horizonte, MG, Brasil
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Patologia, Belo Horizonte, MG, Brasil
| | - Camila Amormino Corsini
- Fundação Oswaldo Cruz, Instituto René Rachou, Diagnóstico e Terapia de Doenças Infecciosas e Câncer, Belo Horizonte, MG, Brasil
| | - Nathalie Bonatti Franco Almeida
- Fundação Oswaldo Cruz, Instituto René Rachou, Diagnóstico e Terapia de Doenças Infecciosas e Câncer, Belo Horizonte, MG, Brasil
- Universidade da Geórgia, Faculdade de Medicina Veterinária, Departamento de Doenças Infecciosas, Athens, GA, Estados Unidos da América
| | - Maria Luysa Camargos Pedrosa
- Fundação Oswaldo Cruz, Instituto René Rachou, Diagnóstico e Terapia de Doenças Infecciosas e Câncer, Belo Horizonte, MG, Brasil
| | - Daniel Alvim Pena de Miranda
- Fundação Oswaldo Cruz, Instituto René Rachou, Diagnóstico e Terapia de Doenças Infecciosas e Câncer, Belo Horizonte, MG, Brasil
| | - Sarah Vieira Contin Gomes
- Fundação Oswaldo Cruz, Instituto René Rachou, Diagnóstico e Terapia de Doenças Infecciosas e Câncer, Belo Horizonte, MG, Brasil
| | - Jéssica Vieira de Assis
- Fundação Oswaldo Cruz, Instituto René Rachou, Diagnóstico e Terapia de Doenças Infecciosas e Câncer, Belo Horizonte, MG, Brasil
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Patologia, Belo Horizonte, MG, Brasil
| | | | | | | | | | | | - Wander de Jesus Jeremias
- Fundação Oswaldo Cruz, Instituto René Rachou, Diagnóstico e Terapia de Doenças Infecciosas e Câncer, Belo Horizonte, MG, Brasil
- Universidade Federal de Ouro Preto, Departamento de Farmácia, Ouro Preto, MG, Brasil
| | | | - Rafaella Fortini Grenfell E Queiroz
- Fundação Oswaldo Cruz, Instituto René Rachou, Diagnóstico e Terapia de Doenças Infecciosas e Câncer, Belo Horizonte, MG, Brasil
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Patologia, Belo Horizonte, MG, Brasil
- Universidade da Geórgia, Faculdade de Medicina Veterinária, Departamento de Doenças Infecciosas, Athens, GA, Estados Unidos da América
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5
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Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol 2023; 21:133-146. [PMID: 36639608 PMCID: PMC9839201 DOI: 10.1038/s41579-022-00846-2] [Citation(s) in RCA: 1041] [Impact Index Per Article: 1041.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/15/2023]
Abstract
Long COVID is an often debilitating illness that occurs in at least 10% of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. More than 200 symptoms have been identified with impacts on multiple organ systems. At least 65 million individuals worldwide are estimated to have long COVID, with cases increasing daily. Biomedical research has made substantial progress in identifying various pathophysiological changes and risk factors and in characterizing the illness; further, similarities with other viral-onset illnesses such as myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome have laid the groundwork for research in the field. In this Review, we explore the current literature and highlight key findings, the overlap with other conditions, the variable onset of symptoms, long COVID in children and the impact of vaccinations. Although these key findings are critical to understanding long COVID, current diagnostic and treatment options are insufficient, and clinical trials must be prioritized that address leading hypotheses. Additionally, to strengthen long COVID research, future studies must account for biases and SARS-CoV-2 testing issues, build on viral-onset research, be inclusive of marginalized populations and meaningfully engage patients throughout the research process.
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Affiliation(s)
| | | | - Julia Moore Vogel
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA
| | - Eric J Topol
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA.
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6
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Leiser OP, Auberry DL, Bakker E, Chrisler W, Engbrecht K, Engelmann H, Fansler S, Gerbasi V, Hansen J, Hutchinson C, Hutchison J, Lancaster MJ, Lawrence K, Melville A, Mobberley J, O'Bryon I, Oxford KL, Oxford T, Phillips S, Rodda KE, Sanford JA, Schepmoes A, Staley BE, Terrell K, Victry K, Warner C, Omberg KM. Insights from a workplace SARS-CoV-2 specimen collection program, with genomes placed into global sequence phylogeny. PLoS One 2023; 18:e0285042. [PMID: 37115761 PMCID: PMC10146508 DOI: 10.1371/journal.pone.0285042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
In 2020, the Department of Energy established the National Virtual Biotechnology Laboratory (NVBL) to address key challenges associated with COVID-19. As part of that effort, Pacific Northwest National Laboratory (PNNL) established a capability to collect and analyze specimens from employees who self-reported symptoms consistent with the disease. During the spring and fall of 2021, 688 specimens were screened for SARS-CoV-2, with 64 (9.3%) testing positive using reverse-transcriptase quantitative PCR (RT-qPCR). Of these, 36 samples were released for research. All 36 positive samples released for research were sequenced and genotyped. Here, the relationship between patient age and viral load as measured by Ct values was measured and determined to be only weakly significant. Consensus sequences for each sample were placed into a global phylogeny and transmission dynamics were investigated, revealing that the closest relative for many samples was from outside of Washington state, indicating mixing of viral pools within geographic regions.
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Affiliation(s)
- Owen P Leiser
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Seattle, WA, United States of America
| | - Deanna L Auberry
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
| | - Erica Bakker
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
| | - Will Chrisler
- Pacific Northwest National Laboratory, Biological Systems Science, Richland, WA, United States of America
| | - Kristin Engbrecht
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
| | - Heather Engelmann
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
| | - Sarah Fansler
- Pacific Northwest National Laboratory, Environmental Protection & Regulatory Programs, Richland, WA, United States of America
| | - Vincent Gerbasi
- Pacific Northwest National Laboratory, Biological Systems Science, Richland, WA, United States of America
| | - Joshua Hansen
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
| | - Chelsea Hutchinson
- Pacific Northwest National Laboratory, Integrative Omics, Richland, WA, United States of America
| | - Janine Hutchison
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
| | - Mary J Lancaster
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
| | - Kathleen Lawrence
- Pacific Northwest National Laboratory, Biological Systems Science, Richland, WA, United States of America
| | - Angela Melville
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
| | - Jennifer Mobberley
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
| | - Isabelle O'Bryon
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
| | - Kristie L Oxford
- Pacific Northwest National Laboratory, Biological Systems Science, Richland, WA, United States of America
| | - Tessa Oxford
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
| | - Shelby Phillips
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
| | - Kabrena E Rodda
- Pacific Northwest National Laboratory, Radiochemical Analysis, Richland, WA, United States of America
| | - James A Sanford
- Pacific Northwest National Laboratory, Biological Systems Science, Richland, WA, United States of America
| | - Athena Schepmoes
- Pacific Northwest National Laboratory, Biological Systems Science, Richland, WA, United States of America
| | - Brian E Staley
- InCyte Diagnostics, Richland, WA, United States of America
| | - Kelcey Terrell
- InCyte Diagnostics, Richland, WA, United States of America
| | - Kristin Victry
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
| | - Cynthia Warner
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
| | - Kristin M Omberg
- Pacific Northwest National Laboratory, Chemical and Biological Signatures, Richland, WA, United States of America
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Krishna BA, Lim EY, Mactavous L, Lyons PA, Doffinger R, Bradley JR, Smith KGC, Sinclair J, Matheson NJ, Lehner PJ, Wills MR, Sithole N. Evidence of previous SARS-CoV-2 infection in seronegative patients with long COVID. EBioMedicine 2022; 81:104129. [PMID: 35772216 PMCID: PMC9235296 DOI: 10.1016/j.ebiom.2022.104129] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/09/2022] [Accepted: 06/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is currently no consensus on the diagnosis, definition, symptoms, or duration of COVID-19 illness. The diagnostic complexity of Long COVID is compounded in many patients who were or might have been infected with SARS-CoV-2 but not tested during the acute illness and/or are SARS-CoV-2 antibody negative. METHODS Given the diagnostic conundrum of Long COVID, we set out to investigate SARS-CoV-2-specific T cell responses in patients with confirmed SARS-CoV-2 infection and/or Long COVID from a cohort of mostly non-hospitalised patients. FINDINGS We discovered that IL-2 release (but not IFN-γ release) from T cells in response to SARS-CoV-2 peptides is both sensitive (75% +/-13%) and specific (88%+/-7%) for previous SARS-CoV-2 infection >6 months after a positive PCR test. We identified that 42-53% of patients with Long COVID, but without detectable SARS-CoV-2 antibodies, nonetheless have detectable SARS-CoV-2 specific T cell responses. INTERPRETATION Our study reveals evidence (detectable T cell mediated IL-2 release) of previous SARS-CoV-2 infection in seronegative patients with Long COVID. FUNDING This work was funded by the Addenbrooke's Charitable Trust (900276 to NS), NIHR award (G112259 to NS) and supported by the NIHR Cambridge Biomedical Research Centre. NJM is supported by the MRC (TSF MR/T032413/1) and NHSBT (WPA15-02). PJL is supported by the Wellcome Trust (PRF 210688/Z/18/Z, 084957/Z/08/Z), a Medical Research Council research grant MR/V011561/1 and the United Kingdom Research and a Innovation COVID Immunology Consortium grant (MR/V028448/1).
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Affiliation(s)
- Benjamin A Krishna
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge CB2 0AW, UK; Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Eleanor Y Lim
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge CB2 0AW, UK; Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Lenette Mactavous
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Paul A Lyons
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge CB2 0AW, UK; Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Rainer Doffinger
- Department of Clinical Biochemistry and Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - John R Bradley
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, UK; Cambridge NIHR BioResource Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; Department of Renal Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Kenneth G C Smith
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge CB2 0AW, UK; Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| | - John Sinclair
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Nicholas J Matheson
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge CB2 0AW, UK; Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; NHS Blood and Transplant, Cambridge CB2 0PT, UK
| | - Paul J Lehner
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge CB2 0AW, UK; Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Mark R Wills
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge CB2 0AW, UK; Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK.
| | - Nyaradzai Sithole
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge CB2 0AW, UK; Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK.
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8
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Waning of SARS-CoV-2 booster viral-load reduction effectiveness. Nat Commun 2022; 13:1237. [PMID: 35246560 PMCID: PMC8897467 DOI: 10.1038/s41467-022-28936-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/18/2022] [Indexed: 01/07/2023] Open
Abstract
The BNT162b2 COVID-19 vaccine has been shown to reduce viral load of breakthrough infections (BTIs), an important factor affecting infectiousness. This viral-load protective effect has been waning with time post the second vaccine and later restored with a booster shot. It is currently unclear though for how long this regained effectiveness lasts. Analyzing Ct values of SARS-CoV-2 qRT-PCR tests of over 22,000 infections during a Delta-variant-dominant period in Israel, we find that this viral-load reduction effectiveness significantly declines within months post the booster dose. Adjusting for age, sex and calendric date, Ct values of RdRp gene initially increases by 2.7 [CI: 2.3-3.0] relative to unvaccinated in the first month post the booster dose, yet then decays to a difference of 1.3 [CI: 0.7-1.9] in the second month and becomes small and insignificant in the third to fourth months. The rate and magnitude of this post-booster decline in viral-load reduction effectiveness mirror those observed post the second vaccine. These results suggest rapid waning of the booster’s effectiveness in reducing infectiousness, possibly affecting community-level spread of the virus. The BNT162b2 COVID-19 vaccine has been shown to reduce viral load of breakthrough infections (BTIs). Here, analyzing viral loads of BTIs post third vaccine shot, Levine-Tiefenbrun et al. show waning of the booster’s effectiveness in reducing infectiousness within months, mirroring the rate and magnitude of decline observed post the second shot.
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