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Review 1: "Less severe course of COVID-19 is associated with elevated levels of antibodies against seasonal human coronaviruses OC43 and HKU1 (HCoV OC43, HCoV HKU1"

Reviewer: Francisco Ibarrondo (UCLA) | 📙📙 ◻️◻️◻️

Published onMay 04, 2022
Review 1: "Less severe course of COVID-19 is associated with elevated levels of antibodies against seasonal human coronaviruses OC43 and HKU1 (HCoV OC43, HCoV HKU1"
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Less severe course of COVID-19 is associated with elevated levels of antibodies against seasonal human coronaviruses OC43 and HKU1 (HCoV OC43, HCoV HKU1)
Description

AbstractThe clinical course of COVID-19 is very heterogeneous: Most infected individuals can be managed in an outpatient setting, but a substantial proportion of patients requires intensive care, resulting in a high rate of fatalities. Recently, an association between contact to small children and mild course of COVID-19 was reported. We performed an observational study to assess the impact of previous infections with seasonal coronaviruses on COVID-19 severity. 60 patients with confirmed COVID-19 infections were included (age 30 - 82 years; 52 males, 8 females): 19 inpatients with critical disease, 16 inpatients with severe or moderate disease and 25 outpatients (age and gender matched to inpatients). Patients with critical disease had significantly lower levels of HCoV OC43- (p=0.016) and HCoV HKU1-specific (p=0.023) antibodies at the first encounter compared to other COVID-19 patients. Our results indicate that previous infections with seasonal coronaviruses might protect against a severe course of disease. This finding should be validated in other settings and could contribute to identify persons at risk before an infection.

RR:C19 Evidence Scale rating by reviewer:

Not informative. The flaws in the data and methods in this study are sufficiently serious that they do not substantially justify the claims made. It is not possible to say whether the results and conclusions would match that of the hypothetical ideal study. The study should not be considered as evidence by decision-makers.

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Review:

The main claims made are not strongly justified by the methods and data but may yield some insight. The results and conclusions of the study may resemble those from the hypothetical ideal study, but there is substantial room for doubt.

The authors address an intriguing question: the possibility that previous exposure to seasonal coronavirus confers some protection against SARS-Cov2. This idea has been discussed in the literature and although it deserves some attention, it is still a controversial one. Antibody cross-reactivity does not guarantee neutralization activity. Antibodies isolated from a SARS patient showing high cross-reactivity with SAR-Cov2 RBD do not neutralize it.

Unfortunately, in this study, the main piece of information is derived from comparisons of ordinal data that are inheritably prone to subjective interpretation. It is also unclear if the significant statistical differences in antibody levels found between non-critical and critical patients in figure 1 refer to strong intensity bands, above the cutoff band, or to both together. These differences are not supported by their subsequent quantitative analysis based on image analysis of the same immunostrips. Although the study deserves some merit, it is far from conclusive: the data do not support the hypothesis and the utilized methodology is unreliable.

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