Serological assay for anti-SARS-CoV-2 antibodies improves sensitivity of diagnosis of COVID-19 patients

The emergence of SARS-CoV-2, responsible for coronavirus disease-2019 (COVID-19), has become a major global health problem. The molecular testing is the accepted assay in SARS-CoV-2 detection. However, there are several reasons for low sensitivity by RNA detection, causing challenges in SARS-CoV-2 diagnosis. In this study, we aimed to investigate serological patterns of SARS-CoV-2 specific IgM, and IgG in 111 hospitalized, and 34 recovered COVID-19 patients and 311 prepandemic normal serum specimens by ELISA. The validity of the ELISA kits was evaluated using samples from normal and recovered cases. This showed that 98.1%, and 98.4% of prepandemic normal samples were negative for anti-SARS-CoV-2 IgM, and IgG, respectively. Assessment of 34 COVID-19 confirmed recovered patients showed a test sensitivity of 76.5%, and 94.1% for IgM, and IgG, respectively. In COVID-19 hospitalized patients, 42.3%, and 51.4% were positive for IgM and IgG, respectively. Viral RNA was not detectable in 43.3% of the hospitalized patients. Interestingly, combined molecular and serological testing improved the sensitivity of COVID-19 diagnosis to 79.6%. Using PCR with combined IgM/IgG results augmented the patient diagnosis sensitivity to 65.3% and 87.2% in ≤ 7 days, and > 7 days intervals, respectively. Overall, serological tests in combination with PCR can improve the sensitivity of COVID-19 diagnosis.