Antibody responses to SARS-CoV-2 in patients with differing severities of coronavirus disease 2019

PLoS One. 2020 Oct 9;15(10):e0240502. doi: 10.1371/journal.pone.0240502. eCollection 2020.


Background: A greater understanding of the antibody response to SARS-CoV-2 in an infected population is important for the development of a vaccination.

Aim: To investigate SARS-CoV-2 IgA and IgG antibodies in Thai patients with differing severities of COVID-19.

Methods: Plasma from the following patient groups was examined: 118 adult patients with confirmed SARS-CoV-2 infections, 49 patients under investigation (without confirmed infections), 20 patients with other respiratory infections, and 102 healthy control patients. Anti-SARS-CoV-2 enzyme-linked immunosorbent assay (ELISA) from EUROIMMUN was performed to assess for IgA and IgG antibodies. The optical density (OD) ratio cutoff for a positive result was 1.1 for IgA and 0.8 for IgG. Additionally, the association of the antibody response with both the severity of disease and the date after onset of symptoms was analyzed.

Results: A total of 289 participants were enrolled and 384 samples analyzed from March 10 to May 31, 2020. Patients were categorized, based on their clinical manifestations, as mild (n = 59), moderate (n = 27), or severe (n = 32). The overall sensitivity of IgA and IgG from the samples collected after day 7 of the symptoms was 87.9% (95% CI: 79.8-93.6) and 84.8% (95% CI: 76.2-91.3), respectively. Compared to the mild group, the severe group had significantly higher levels of spike 1 (S1) antigen-specific IgA and IgG. All patients in the moderate and severe groups had S1-specific IgG, while 20% of the patients in the mild group did not have any IgG detected after two weeks after the onset of symptoms. Interestingly, in the severe group, the SARS-CoV-2 IgG level was significantly higher in males than females (p = 0.003).

Conclusion: The serological test for SARS-CoV-2 has a high sensitivity more than two weeks after the onset of illness. Additionally, the serological response differs among patients based on sex as well as the severity of infection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antibodies, Viral / blood*
  • Antibody Formation
  • Betacoronavirus / genetics
  • Betacoronavirus / immunology*
  • Betacoronavirus / isolation & purification
  • COVID-19
  • Case-Control Studies
  • Coronavirus Infections / immunology
  • Coronavirus Infections / pathology*
  • Coronavirus Infections / virology
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Humans
  • Immunoglobulin G / blood
  • Immunoglobulin M / blood
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / immunology
  • Pneumonia, Viral / pathology*
  • Pneumonia, Viral / virology
  • RNA, Viral / genetics
  • RNA, Viral / metabolism
  • Real-Time Polymerase Chain Reaction
  • SARS-CoV-2
  • Severity of Illness Index
  • Sex Factors
  • Spike Glycoprotein, Coronavirus / immunology


  • Antibodies, Viral
  • Immunoglobulin G
  • Immunoglobulin M
  • RNA, Viral
  • Spike Glycoprotein, Coronavirus
  • spike glycoprotein, SARS-CoV

Grants and funding

This work was supported by funding to support Biobank from Ratchadapisek Sompoch Fund, Faculty of Medicine, Chulalongkorn University.