Virological and Serological Assessment of US Army Trainees Isolated for Coronavirus Disease 2019

Shilpa Hakre*, Ines Lakhal-Naouar, David B. King, Jennifer L. Burns, Kenya N. Jackson, Stephen W. Krauss, Prabha Chandrasekaran, Melanie D. McCauley, Brittany L. Ober Shepherd, Samantha McHenry, Elizabeth J. Bianchi, Jason Ouellette, Janice M. Darden, Aaron D. Sanborn, Sharon P. Daye, Paul O. Kwon, Jeremiah Stubbs, Crystal L. Brigantti, Tara L. Hall, Milford H. BeagleJason A. Pieri, Timothy R. Frambes, Robert J. O'Connell, Kayvon Modjarrad, Clinton K. Murray, Linda L. Jagodzinski, Paul T. Scott, Sheila A. Peel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Laboratory screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a key mitigation measure to avoid the spread of infection among recruits starting basic combat training in a congregate setting. Because viral nucleic acid can be detected persistently after recovery, we evaluated other laboratory markers to distinguish recruits who could proceed with training from those who were infected. Methods: Recruits isolated for coronavirus disease 2019 (COVID-19) were serially tested for SARS-CoV-2 subgenomic ribonucleic acid (sgRNA), and viral load (VL) by reverse-Transcriptase polymerase chain reaction (RT-PCR), and for anti-SARS-CoV-2. Cluster and quadratic discriminant analyses of results were performed. Results: Among 229 recruits isolated for COVID-19, those with a RT-PCR cycle threshold >30.49 (sensitivity 95%, specificity 96%) or having sgRNA log10 RNA copies/mL <3.09 (sensitivity and specificity 96%) at entry into isolation were likely SARS-CoV-2 uninfected. Viral load >4.58 log10 RNA copies/mL or anti-SARS-CoV-2 signal-To-cutoff ratio <1.38 (VL: sensitivity and specificity 93%; anti-SARS-CoV-2: sensitivity 83%, specificity 79%) had comparatively lower sensitivity and specificity when used alone for discrimination of infected from uninfected. Conclusions: Orthogonal laboratory assays used in combination with RT-PCR may have utility in determining SARS-CoV-2 infection status for decisions regarding isolation.

Original languageEnglish
Pages (from-to)1743-1752
Number of pages10
JournalJournal of Infectious Diseases
Issue number10
StatePublished - 15 Nov 2022
Externally publishedYes


  • Army recruit
  • SARS-CoV-2
  • cycle threshold value
  • isolation
  • sgRNA


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