Time dependent decline of neutralizing antibody titers in COVID-19 patients from Pune, India and evidence of reinfection.

PURPOSE: To assess modulation of neutralizing antibody titers in COVID-19 patients and understand association of variables such as age, presence of comorbidity, BMI and gender with antibody titers. METHODS: Patients (n = 100) diagnosed from 20th March 2020 to 17th August 2020 and treated at two large hospitals from Pune, India were included and followed up (clinical and serologic) for varied periods. IgG-anti-SARS-CoV-2 (Spike protein-based ELISA) and neutralizing antibody titers (NAb, PRNT) were determined in all the samples. RESULTS: Of the 100 patients enrolled initially (median 60 days of diagnosis), follow up samples were collected from 70 patients (median 106 days of diagnosis). Overall, NAb titers reduced significantly (p < 0.001) and as early as 3-4 months. During two visits, 20% and 7.1% patients reported some symptoms. At the first visit, NAb titers were higher in patients with severe disease (p < 0.001), comorbidities (p < 0.005), age <50 years (p < 0.05) and male gender (p < 0.05). Multivariate analysis identified older age (p < 0.001), duration post-diagnosis and female gender as independent variables influencing NAb titers (negative correlation, p < 0.05). During the follow-up, reduction in NAb titers was recorded in patients with comorbidity (p < 0.05), mild disease (p < 0.05), age <50 years (p < 0.05), higher BMI (p < 0.05) and male gender (p < 0.001). Serology identified six cases of asymptomatic reinfections. CONCLUSIONS: Decline of NAb titers was associated with age <50 years, mild disease, comorbidities, higher BMI and male gender. At the time of follow up, 8/70 (11.4%) patients lacked neutralizing antibodies. Evidence of 6 probable asymptomatic reinfections suggests waning of immunity, but, probable protection from clinical disease needing hospitalization.

Elevated Levels of Neutrophil Activated Proteins, Alpha-Defensins (DEFA1), Calprotectin (S100A8/A9) and Myeloperoxidase (MPO) Are Associated With Disease Severity in COVID-19 Patients.

Understanding of the basis for severity and fatal outcome of SARS-CoV-2 infection is of paramount importance for developing therapeutic options and identification of prognostic markers. So far, accumulation of neutrophils and increased levels of pro-inflammatory cytokines are associated with disease severity in COVID-19 patients. In this study, we aimed to compare circulatory levels of neutrophil secretory proteins, alpha-defensins (DEFA1), calprotectin (S100A8/A9), and myeloperoxidase (MPO) in COVID-19 patients with different clinical presentations. We studied 19 healthy subjects, 63 COVID-19 patients with mild (n=32) and severe (n=31) disease, 23 asymptomatic individuals identified through contact tracing programme and 23 recovering patients (1-4 months post-disease). At the time of disease presentation, serum levels of DEFA1 were significantly higher in patients with mild (mean230 ± 17, p<0.0001) and severe (mean452 ± 46, p<0.0001) disease respectively in comparison to healthy subjects (mean113 ± 11). S100A8/A9 proteins were significantly higher in COVID-19 patients (p<0.0001) irrespective of disease severity. The levels of DEFA1, S100A8/A9 and MPO reduced to normal in recovering patients and comparable to healthy subjects. Surprisingly, DEFA1 levels were higher in severe than mild patients in first week of onset of disease (p=0.004). Odds-ratio analysis showed that DEFA1 could act as potential biomarker in predicting disease severity (OR=11.34). In addition, levels of DEFA1 and S100A8/A9 were significantly higher in patients with fatal outcome (p=0.004 and p=0.03) respectively. The rise in DEFA1 levels was independent of secondary infections. In conclusion, our data suggest that induction of elevated levels of alpha-defensins and S100A8/A9 is associated with poor disease outcome in COVID-19 patients.

Knowledge, Attitudes, and Practices Toward Coronavirus Disease 2019, Among People in a Tertiary Care Hospital in India

Background Novel coronavirus disease 2019 (COVID-19) has rapidly spread across the entire globe causing a lot of fear among the masses. India had more than 2,500 confirmed cases and more than 70 deaths at the time of submission of this article. This is probably the first study from India on the knowledge, attitudes, and practices toward COVID-19. Presently, there is only 1 similar study from China. Methods A cross-sectional observational study was performed in a tertiary care hospital in India to assess the knowledge, attitudes, and practices of the participants toward COVID-19 during the pandemic. The participants had to answer a questionnaire in the language well understood by them. It pertained to their basic knowledge about this disease, their attitudes, and correct practices. The participants were either doctors, staff, patients, or relatives visiting the hospital. Results Among the various age groups, the highest proportion (57.21%) of very good knowledge was in the 20 to 30 years age group. Among the respondents, poor knowledge was seen in the patients. Overall, 47.99% participants had an extremely optimistic attitude, whereas <50% doctors had extremely correct practices toward COVID-19. This is unacceptable during the ongoing pandemic and reveals scope for improvement. Conclusions The public health authorities at the regional and state level can use this information to increase awareness among the population, which may help to contain the pandemic. Educational campaigns targeting the correct population groups are essential to reduce the public anxiety toward this pandemic. Correspondence to: Purwa Doke, MD, Department of Infectious Diseases, Bharati Vidyapeeth Deemed University Medical College, Plot 51, Saikripa Society, Dhankawdi, Pune, Maharshtra, India 411043. E-mail: purwadoke@gmail.com. The authors have no funding or conflicts of interest to disclose. This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.