Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections

Long, Q., Tang, X., Shi, Q., et al.

The clinical features and immune responses of asymptomatic individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have not been well described. We studied 37 asymptomatic individuals in the Wanzhou District who were diagnosed with RT-PCR-confirmed SARS-CoV-2 infections but without any relevant clinical symptoms in the preceding 14 days and during hospitalisation. Asymptomatic individuals were admitted to the government-designated Wanzhou People’s Hospital for centralised isolation in accordance with policy. The median duration of viral shedding in the asymptomatic group was 19 days (interquartile range (IQR), 15-26 days). The asymptomatic group had a significantly longer duration of viral shedding than the symptomatic group (log-rank P=0.028). The virus-specific IgG levels in the asymptomatic group (median S/CO, 3.4; IQR, 1.6-10.7) were significantly lower (P=0.005) relative to the symptomatic group (median S/CO, 20.5; IQR, 5.8-38.2) in the acute phase. Of asymptomatic individuals, 93.3% (28/30) and 81.1% (30/37) had reduction in IgG and neutralising antibody levels, respectively, during the early convalescent phase, as compared to 96.8% (30/31) and 62.2% (23/37) of symptomatic patients. Forty percent of asymptomatic individuals became seronegative and 12.9% of the symptomatic group became negative for IgG in the early convalescent phase. In addition, asymptomatic individuals exhibited lower levels of 18 pro- and anti-inflammatory cytokines. These data suggest that asymptomatic individuals had a weaker immune response to SARS-CoV-2 infection. The reduction in IgG and neutralising antibody levels in the early convalescent phase might have implications for immunity strategy and serological surveys.

Nature Medicine. 2020; 26 (8): 1200-1204.