Review of current advances in serologic testing for COVID-19

Andrea P. Espejo, Yamac Akgun, Abdulaziz F. Al Mana, Youley Tjendra, Nicolas C. Millan, Carmen Gomez-Fernandez, Carolyn Cray

Research output: Contribution to journalReview articlepeer-review

117 Scopus citations


Objectives: To examine and summarize the current literature on serologic methods for the detection of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: A literature review was performed using searches in databases including PubMed, medRxiv, and bioRxiv. Thirty-two peer-reviewed papers and 23 preprints were examined. Results: The studies included lateral flow immunoassay, enzyme-linked immunosorbent assay, chemiluminescence immunoassay, and neutralizing antibody assays. The use of all major SARS-CoV-2 antigens was demonstrated to have diagnostic value. Assays measuring total antibody reactivity had the highest sensitivity. In addition, all the methods provided opportunities to characterize the humoral immune response by isotype. The combined use of IgM and IgG detection resulted in a higher sensitivity than that observed when detecting either isotype alone. Although IgA was rarely studied, it was also demonstrated to be a sensitive marker of infection, and levels correlated with disease severity and neutralizing activity. Conclusions: The use of serologic testing, in conjunction with reverse transcription polymerase chain reaction testing, was demonstrated to significantly increase the sensitivity of detection of patients infected with SARS-CoV-2. There was conflicting evidence regarding whether antibody titers correlated with clinical severity. However, preliminary investigations indicated some immunoassays may be a surrogate for the prediction of neutralizing antibody titers and the selection of recovered patients for convalescent serum donation.

Original languageEnglish (US)
Pages (from-to)293-304
Number of pages12
JournalAmerican journal of clinical pathology
Issue number3
StatePublished - 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© American Society for Clinical Pathology, 2020. All rights reserved.


  • COVID-19
  • Chemiluminescence immunoassay (CLIA)
  • Convalescent serum
  • Coronavirus
  • Enzyme-linked immunosorbent assay (ELISA)
  • Immunoassays
  • Lateral flow immunoassay (LFIA)
  • Plaque reduction neutralization test (PRNT)
  • SARS-CoV-2
  • Serology


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