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Accurate serologic tests to detect host antibodies to severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) will be critical for the public health response to the coronavirus disease 2019 pandemic. Many use cases are envisaged, including complementing molecular methods for diagnosis of active disease and estimating immunity for individuals. At the population level, carefully designed seroepidemiologic studies will aid in the characterization of transmission dynamics and refinement of disease burden estimates and will provide insight into the kinetics of humoral immunity. Yet, despite an explosion in the number and availability of serologic assays to test for antibodies against SARS-CoV-2, most have undergone minimal external validation to date. This hinders assay selection and implementation, as well as interpretation of study results. In addition, critical knowledge gaps remain regarding serologic correlates of protection from infection or disease, and the degree to which these assays cross-react with antibodies against related coronaviruses. This article discusses key use cases for SARS-CoV-2 antibody detection tests and their application to serologic studies, reviews currently available assays, highlights key areas of ongoing research, and proposes potential strategies for test implementation.

Original publication

DOI

10.7326/m20-2854

Type

Journal

Annals of internal medicine

Publication Date

09/2020

Volume

173

Pages

450 - 460

Addresses

McGill University Health Centre and McGill Interdisciplinary Initiative in Infection and Immunity, Montreal, Quebec, Canada (M.P.C.).

Keywords

Humans, Pneumonia, Viral, Coronavirus Infections, Serologic Tests, Clinical Laboratory Techniques, Seroepidemiologic Studies, Pandemics, Betacoronavirus, COVID-19, SARS-CoV-2, COVID-19 Testing