The inclusion criterion for this prospective cohort study was confirmed COVID-19 infection, defined as positive SARS-CoV-2 PCR from any respiratory sample. On the basis of the different decay dynamics, we established a prediction algorithm that revealed a wide range of neutralising antibody longevity, varying from around 40 days to many decades. By contrast, T-cell responses were similar among the different neutralising antibody dynamics groups. Persistence of neutralising antibodies was associated with disease severity and sustained level of pro-inflammatory cytokines, chemokines, and growth factors. We identified five distinctive patterns of neutralising antibody dynamics as follows: negative, individuals who did not, at our intervals of sampling, develop neutralising antibodies at the 30% inhibition level (19 of 164 patients) rapid waning, individuals who had varying levels of neutralising antibodies from around 20 days after symptom onset, but seroreverted in less than 180 days (44 of 164 patients) slow waning, individuals who remained neutralising antibody-positive at 180 days post-symptom onset (46 of 164 patients) persistent, although with varying peak neutralising antibody levels, these individuals had minimal neutralising antibody decay (52 of 164 patients) and delayed response, a small group that showed an unexpected increase of neutralising antibodies during late convalescence (at 90 or 180 days after symptom onset three of 164 patients). 164 patients were followed up and had adequate blood samples collected for analysis, with a total of 546 serum samples collected, including 128 blood samples taken up to 180 days post-symptom onset.
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We approached 517 patients for participation in the study, of whom 288 consented for outpatient follow-up and collection of serial blood samples. The Lancet Regional Health – Western Pacific.The Lancet Regional Health – Southeast Asia.
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