ABSTRACT
Background: The infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2), the causal agent of coronavirus disease 2019 (COVID-19), is associated with coagulation abnormalities, in which endothelial injury/dysfunction may be a key pathogenic mechanism. Endothelial dysfunction triggers tissue factor (TF) expression. Activated factor VII-antithrombin (FVIIa-AT) complex is a potential biomarker of prothrombotic diathesis reflecting FVIIa-TF interaction. Aim(s): To evaluate FVIIa-AT plasma levels in subjects with COVID-19 pneumonia. Method(s): FVIIa-AT plasma levels were assessed in 40 subjects (30 males and 10 females;64.8 +/- 12.3 years) admitted for COVID-19 pneumonia during the first pandemic wave in Italy (April 2020). FVIIa-AT levels were compared with those of two sex-and age-matched groups of hospitalized subjects without COVID-19, with or without laboratory signs of systemic inflammation. The concentration of FVIIa-AT was measured by ELISA on frozen citrate plasma samples. Data of coagulant activities of factor II (FII:c), factor V (FV:c), and factor VIII (FVIII:c) were available in a subgroup of subjects. Result(s): Hospitalized COVID-19 patients had FVIIa-AT levels significantly higher than sex-and age-matched no COVID-19 subjects (Table 1), either with or without inflammation (p = 0.013 and p = 0.017 by ANOVA with Tukey post-hoc comparison, respectively). No difference in FVIIa-AT levels was observed between no COVID-19 subjects with or without inflammation (p = 0.995). The association between COVID-19 and FVIIa-AT levels in the whole study sample remained significant by linear regression analysis adjusted for sex, age, C reactive protein, estimated glomerular filtration rate, fibrinogen, prothrombin time, and activated partial thromboplastin time (B coefficient 0.322 with standard error 0135, p = 0.019). In sub-analysis COVID-19 patients showed also lower FII:c, FV:c, and FVIII:c levels (Table 1). Conclusion(s): Our results indicate that SARS-CoV2 infection, at least during the first pandemic wave, was characterized by increased FVIIa-AT levels, thereby suggesting an increased FVIIa-TF interaction, which may be consistent with increased TF expression/activation due to SARS-CoV2 -induced endotheliopathy.
ABSTRACT
Background SARS-CoV-2 pandemic is causing high morbidity and mortality burden worldwide. Mechanism of infection, protection or rapid evolution until fatal outcome of the disease remains poorly understood. To elucidate the dynamics of humoral response in SARS-CoV-2 asymptomatic and symptomatic infections, we performed a study to investigate the time course of antibody response in hospitalized COVID-19 patients and asymptomatic SARS-CoV-2 infected subjects. Methods Serum samples were collected from 42 hospitalized COVID-19 patients at 6 different time points (hospital admission, day 2, day 6, day 12-14, day 18-20, day 27-30) and from 25 asymptomatic subjects at 3 different time points (at the time of positive swab, 2 months, 6 months). Samples were tested by commercial ELISA for SARS-CoV-2 spike (S) protein IgA, IgM, and IgG and nucleoprotein (NP) IgG, and by micro-neutralization assay. Results In patients, titres increased for all antibody classes including neutralizing antibody from day 6 to day 18-20 but at day 27-30 started to decline. A high correlation between S and NP antigens and among antibody classes was found. No significant difference in antibody titres at baseline and by peak antibody level was found between recovered and deceased. 64.0% of asymptomatic subjects were negative to any antibody at any time point. Asymptomatic subjects with positive antibody level had titres well below patients, and neutralizing antibodies were found only in 2 subjects (8.0%). Conclusions Our results highlight that COVID-19 patients produce an antibody response to SARS-CoV-2 regardless the outcome. The peak is reached by 3 weeks from hospital admission followed by a sharp decrease. On the contrary, only few asymptomatic subjects develop antibodies at detectable levels, though lower compared to COVID-19 patients. Since neutralizing antibodies were rarely produced, this finding raises the question about the protection of these subjects against reinfection. Key messages COVID-19 patients produce an antibody response to SARS-CoV-2 which does not differ between recovered and deceased. Only few asymptomatic SARS-CoV-2 infected subjects develop antibodies and neutralizing antibodies were rarely produced.
ABSTRACT
Background Italy has been one of the first countries hit by the COVID-19 pandemic. On 22 February, 2020, clusters of infection in Northern Italy were reported and transmission was assumed to be local. The presence of SARS-CoV-2 in wastewaters in Italy in late December 2019 suggested that the virus has been silently circulating before the first autochthonous case was identified. This study aimed to retrospectively assess the presence of antibodies against SARS-CoV-2 in a sample population from Southern Italy in the last months of 2019. Methods Human serum samples were collected from late September to the end of December 2019 in a local laboratory in the province of Bari, Apulia region, Southern Italy. A total of 455 samples were tested for SARS-CoV-2 IgA, IgM, and IgG by commercial ELISA. Samples with borderline or positive result for at least one antibody class were further tested by in house-ELISA for IgA, IgM, and IgG targeting the receptor-binding domain (RBD) of the spike protein of SARS-CoV-2 and by micro-neutralization test (MNT). Results After commercial ELISA testing, 11 samples were positive for IgG, 3 for IgM, and 3 and 2 were positive and borderline for IgA, respectively. 8 samples (1.8%, 95% CI 0.8-3.4) were positive when tested by in house-ELISA: 5 (1.1%, 95% CI 0.4-2.5) for IgG and 3 (0.7%, 95% CI 0.1-1.9) for IgM. No samples were positive for in house-ELISA IgA or by MNT. Conclusions The results of this study showed that some samples collected before the first autochthonous case was detected in Italy had antibodies reactive to the RBD of SARS-CoV-2. The Apulia region has been less severely affected by the first epidemic wave than the northern regions;however, these results suggest the spread of SARS-CoV-2 in the population in the late months of 2019. Since the majority of SARS-CoV-2 infections does not require hospitalization, it is possible that many of these have gone unnoticed. Key messages The spread of SARS-CoV-2 in the Italian population could have already occurred in late 2019. The extent of SARS-CoV-2 infections in the population could be far greater than reported.
ABSTRACT
Aims This is a prospective observational web-based survey aimed to assess the impact of SARS-CoV-2 pandemic onGastroenterology Units in Italy. Methods All members of the Italian Society of Gastroenterology (SIGE) were invited to answer a 39-point multiple-choiceweb-based survey between March 30 thand April 7 th2020. Results Data of 121 hospitals from all 20 Italian regions were analyzed. Overall, 10.7 % of Gastroenterology divisions havebeen converted to COVID Units. Outpatients consultations, endoscopic and ultrasound procedures were limited to urgenciesand oncology indications in 85.1 %, 96.2 % and 72.2 % of Units, respectively, and 46.7 % of Units suspended the screeningfor colorectal cancer.In order to guarantee the ordinary follow-up of outpatients, 83/121 (68.6 %) divisions activated aremote consultancy service (63.9 % by phone, 31.3 % by email, 4.8 % by video). Overall, 112/121 (92.6 %) GI Units issued and followed a specific protocol for the management of patients with suspectedor confirmed SARS-CoV-2 infection. The 72.2 % of the staff received proper training for the use of personal protective equipment, although 45.5 % did not havesufficient devices for an adequate replacement. With regard to PPE availability, N95/FFP2-3 masks were available in 91/121 (75.2 %), surgical masks in 115/121 (95.0 %),gloves in 117/121 (96.7 %), disposable gown in 100/121 (82.6 %), hairnet in 104/121 (85.9 %), goggles in 78/121 (64.5 %)and boots in 57/121 (47.1 %) of divisions. Finally, in 41/121 GI divisions (33.9 %) there was at least one healthcare professional who got infected, in a total of 132subjects, of which 121/132 from divisions not-converted to COVID Units and 75/132 from high-prevalence areas. Conclusions Substantial changes of practice and reduction of procedures have been recorded in the entire country duringthe first wave of the pandemic. The long-term impact of such modifications is difficult to estimate but potentially very riskyfor many digestive diseases.