key: cord-0706219-pmkbmrnq
authors: Shang, Yufeng; Liang, Yuxing; Liu, Tao; Li, Jingfeng; Zhou, Fuling
title: Public screening for COVID‐19 in Wuhan, China and beware of the antibody positive in women and tumor patients
date: 2021-12-08
journal: J Med Virol
DOI: 10.1002/jmv.27483
sha: e0cdf1631ecf299b2dae7eabc80eb3491dd801d4
doc_id: 706219
cord_uid: pmkbmrnq

The novel coronavirus disease 2019 (COVID‐19) has become a global health emergency. Early detection and intervention are key factors for improving outcomes in patients with COVID‐19. Real‐time reverse transcriptase polymerase chain reaction‐based molecular assays and antibody for detecting SARS‐CoV‐2 in respiratory specimens are the current reference standard for COVID‐19 diagnosis. Clinical implications of different specimen types for nucleic acid and antibody testing of COVID‐19 in Zhongnan hospital of Wuhan University were analyzed. Compared with health groups, tumor patients had higher rate of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) (+/−) immunoglobulin M (IgM) (+) immunoglobulin G (IgG) (+). The rate of SARS‐CoV‐2 (−) IgM (+) IgG (−) or SARS‐CoV‐2 (−) IgM (−) IgG (+) in female was significantly higher than that in male. These results can help governments to take screening measures to prevent the COVID‐19 pandemic again.

SARS-CoV-2 viral nucleic acid was test by high throughput sequencing or real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens, which were performed following a previously method. 2 IgM/IgG test kits included recombinant SARS-CoV-2 antigens (spike protein and nucleocapsid protein) labelled with magnetic beads (tested on a fully-automated chemiluminescence immunoassay analyzer) or colloidal gold (test card), anti-human IgM monoclonal antibody, and anti-human IgG monoclonal antibody. These test kits were reported to have high sensitivity and specificity. 3, 4 According to the manufacturers, the sensitivity and specificity are~90% and >99% for IgM, and~98% and~98% for IgG, respectively.

Basic information including case category (patient groups, health groups), sex, age, testing results and data of COVID-19 IgM/IgG and nucleic acid were collected from system of laboratory medicine. For hospitalized patients, diseases were divided into different categories: including patients with malignant tumor, chronic diseases, or immunerelated diseases (such as Crohn's Disease, Inflammatory Bowel Disease, Connective Tissue Disease). Distribution characteristics were compared between cases with nucleic acid or IgM/IgG positive and negative.

Of the 21 398 cases, there were 4093 hospitalized patients and 17 305 health cases. The number of male (52.5%) was slightly higher than that of female (47.5%). Median age was 40.0 years (interquartile range: 31.0-53.0) ( Table 1 ). In total, only 12 (0.056%) cases were SARS-CoV-2 positive, 254 (1.19%) cases were IgM positive and 978 (4.57%) cases were IgG positive. There are some suspected cases, which is difficult to distinguish whether IgM/IgG is positive or negative. The positive prevalence of IgM/IgG antibodies to SARS-CoV-2 and nucleic acids are shown in Table 2 . (Table 3) .

For patient groups, compared with health groups, tumor patients had higher rate of SARS-CoV-2 (+/−) IgM (+) IgG (+) (p = 0.003) and SARS-CoV-2 (−) IgM (−) IgG (+) (p = 0.007, Figure 1E ).

For different age groups, no SARS-CoV-2 (−) IgM (+) IgG (−) was found in child. SARS-CoV-2 (−) IgM (+) IgG (−) prevalence is higher in female than in male only in the 15-59 age group (p < 0.001, Table 4 ).

In terms of cases with 15-59 age group, the prevalence of SARS-CoV-2 (−) IgM (+) IgG (−) in March (p = 0.031) and April (p < 0.001) was still higher in female than in male. In health group, SARS-CoV-2 (−) IgM (+) IgG (−) prevalence was also higher in female than male (Table 5) . The rate of SARS-CoV-2 (−) IgM (+) IgG (−) or SARS-CoV-2 (−) IgM (−) IgG (+) in female was significantly higher than that in male (p < 0.05). However, previous studies have shown that the number of women infected with SARS-CoV-2 is not more than that of men. [10] [11] [12] It was reported that estrogens promoted the production of natural neutralizing antibodies. 13 In a study of Wuhan Red Cross Hospital, from days 8 to 33 after infection symptoms appeared, 94.83% of the COVID-19 patients had both IgM and IgG positive, and 1.72%, 3.45%

had only IgM or only IgG positive. 4 We speculate that high rate of SARS-CoV-2 (−) IgM (+) IgG (+) in female may be due to the effect of estrogen, which need to be further explored in the future. 

The authors declare that there are no conflict of interests. Fuling Zhou http://orcid.org/0000-0003-0982-0382

Strategies to control COVID-19 and future pandemics in Africa and around the globe

Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China

Low prevalence of IgG antibodies to SARS-CoV-2 in cancer patients with COVID-19

Development and clinical application of a rapid IgM-IgG combined antibody test for SARS-CoV-2 infection diagnosis

False-negative results of real-time reverse-transcriptase polymerase chain reaction for severe acute respiratory syndrome coronavirus 2: role of deep-learning-based CT diagnosis and insights from two cases

The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application

Diagnostic value and dynamic variance of serum antibody in coronavirus disease 2019

Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019

Antibody responses to SARS-CoV-2 in patients with COVID-19

Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19

Gender differences in patients with COVID-19: focus on severity and mortality. Front Public Health

Covid-19: Male disadvantage highlights the importance of sex disaggregated data

Estrogens promote the production of natural neutralizing antibodies in fish through g protein-coupled estrogen receptor 1