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    1 Comment for this article
    Concerning cross-reactivity of SARS-CoV-2 antibody testing in prevalence investigation
    Yang Xu, MD | Shanghai University of Medicine and Health Sciences
    Serological testing is a key investigative tool in the COVID-19 prevalence investigation and can identify an infected family or school cluster, especially patients with mild illness. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological testing may help diagnose suspected patients with negative polymerase chain reaction (PCR) results and those with mild or asymptomatic infections (1). This will allow a more accurate determination of the percentage of infected people.

    Jeremias et al. (2) reported SARS-CoV-2 IgG positive rates were 9.8% in healthcare workers and 16.7% in the local population, respectively. However, the authors used an Abbott Architect SARS-CoV-2 IgG CMIA
    test kit, which is designed to detect IgG antibodies to the nucleocapsid protein of SARS-CoV-2 (3).

    SARS-CoV-2 and SARS-CoV patients have cross-reactivity of spike receptor-binding domain (RBD) and nucleocapsid (N) protein. Lv et al. (4) reported plasma samples of patients with COVID-19 that showed significant cross-reactivity with SARS-CoV N protein. The author also reported plasma samples from patients with severe acute respiratory syndrome (SARS) that could significantly cross-react with SARS-CoV-2 spike RBD and N protein (4).

    Grifoni et al. (5) investigated donors who were not exposed to COVID-19 and found SARS-CoV-2 and seasonal “common cold” human coronaviruses patients have cross-reactivity of SARS-CoV-2 T cell epitopes. Approximately 50% SARS-CoV-2 N protein-specific CD4+ T cell responses in COVID-19 cases were detected among non-contact donors. It was determined that non-contact donors have cross-reactivity to SARS-CoV-2 N protein. If the patient shows the N protein cross-reaction and an anti-spike or nucleocapsid protein detection kit is used, it may affect the evaluation of the prevalence survey (1,5).

    Therefore, the cross-reactivity of SARS-CoV-2 antibody testing may affect prevalence survey. The authors should address the limitation of the test kit that is designed to detect IgG antibodies to the nucleocapsid protein of SARS-CoV-2 in the study.


    1. Long Q, Liu B, Deng H, et al. Antibody responses to SARS-CoV-2 in patients with COVID-19. Nat. Med. 2020; 26: 845-848.
    2. Jeremias A, Nguyen J, Levine J, et al. Prevalence of SARS-CoV-2 infection among health care workers in a tertiary community hospital. JAMA Intern Med. Published online Aug 11, 2020. doi: 10.1001/jamainternmed.2020.4214.
    3. EUA authorized serology test performance. https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/eua-authorized-serology-test-performance
    4. Lv H, Wu NC, Tsang OT, et al. Cross-reactive antibody response between SARSCoV-2 and SARS-CoV infections. Cell Rep. 2020; 31:107725. doi: 10.1016/j.celrep.2020.107725.
    5. Grifoni, A., Weiskopf, D., Ramirez, S.I., et al. Targets of T cell responses to SARS-CoV-2 coronavirus in humans with COVID-19 disease and unexposed individuals. Cell 2020; 181:1489–1501.
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    Research Letter
    August 11, 2020

    Prevalence of SARS-CoV-2 Infection Among Health Care Workers in a Tertiary Community Hospital

    Author Affiliations
    • 1Department of Medicine, St Francis Hospital, The Heart Center, Roslyn, New York
    • 2Department of Biostatistics, St Francis Hospital, The Heart Center, Roslyn, New York
    • 3Department of Laboratory Medicine, St Francis Hospital, The Heart Center, Roslyn, New York
    JAMA Intern Med. Published online August 11, 2020. doi:10.1001/jamainternmed.2020.4214

    New York City and its surrounding metro area have emerged as an epicenter of the coronavirus disease 2019 (COVID-19) outbreak worldwide. A recent population survey1 for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies among those in New York state shows a prevalence of 21.2% in New York City and 16.7% in Long Island. Across the US, up to 11% of reported COVID-19 cases were found to be in health care professionals,2 but the true prevalence of COVID-19 among health care workers is unknown. The aim of the present study is to establish the rate of COVID-19 among health care workers by widespread screening for SARS-CoV-2 exposure.