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and A.M. disease, RT-PCR on feces specimens and serology are even more valuable. Subject conditions:Infectious-disease diagnostics, Virology == Intro == Severe severe respiratory symptoms coronavirus 2 (SARS-CoV-2) offers spread rapidly around the ORM-10103 world since January 20201. In holland, february 2020 the 1st COVID-19 case was detected about 27. From March until Might 2020, the Dutch authorities mandated a partial lockdown. This included sociable distancing, self-quarantine and self-isolation orders, closing of schools, bars and restaurants, ORM-10103 and urging people to work from home2. Yet, households are close-contact settings with high probability of (pre/a-symptomatic) transmission of SARS-CoV-2 after intro of the disease. In this period, a prospective cohort study was performed in households having a confirmed SARS-CoV-2 positive case. All household contacts were tested as soon as possible after the index case was recognized. At multiple timepoints, numerous medical samples were collected for molecular and serological diagnostics. Using a dense sampling strategy, SARS-CoV-2 transmission and kinetics of diagnostic guidelines could be closely monitored within the households. Earlier we explained that the estimated Secondary Attack Rate (SAR) with this cohort that was high (35% in children, 51% in adults), with reduced susceptibility ORM-10103 of children compared to adolescents and adults (0.67; 95%CI 0.401.1)3. Here we looked DR4 further into the use of different specimens and the kinetics of illness. In the present study, we determine participants having a SARS-CoV-2 illness using numerous molecular assays (pointing to acute illness) and serological assays (indicating recent illness), to analyse household transmission patterns in relation to disease severity. Secondly, we describe the dynamics of the illness per individual based on viral RNA and antibody presence. Lastly, we compared the dynamics of the different diagnostic methods (test and sample type), by modeling the outcomes per assay in relation to the days post symptom onset (dps), disease severity and age. == Methods == == Study protocol == A prospective cohort study was performed following households where one symptomatic household member was tested RT-PCR positive for SARS-CoV-2 in the period 24 March6 April 20203. In brief, individuals 18 years and older screening positive for SARS-CoV-2 RT-PCR (i.e. the index case) who experienced at least one child in their household below the age of 18 could be included in this study (METC nr: NL13529.041.06). The study was carried out relating to National recommendations and regulations. The protocol was authorized by the Medical-Ethical Review Committee (METC) of the University Medical Center Utrecht. Informed consent was from all subjects and/or their legal guardian(s). A total of 242 participants from 55 total households were included in this study (Observe Reukers et al.3for more details). The number of analyses performed per assay and specimen type at the various timepoints with the day of the 1st home check out (so the start of the study within the particular household) defined as day time 1 are explained in Table1and Furniture1. We used a different age classification than Reukers et al., foregoing the ‘adolescent’ category, and defining adults mainly because individuals of 18 years of age or older. Individuals are regarded as SARS-CoV-2 illness positive when they tested positive in at least one RT-PCR or serological assay. == Table 1. == Routine of administering questionnaires, sign diaries and home appointments for sampling. The figures in the table indicate the amount of analysed specimens in 242 participants. aA naso- and oropharyngeal swab was not collected for the index case in the 1st home visit, as these individuals were already swabbed a few days before and tested SARS-CoV-2 positive. == COVID-19 severity == The day of onset of possible COVID-19 connected symptoms, i.e. respiratory symptoms (including sore throat, cough, dyspnea or additional respiratory problems, rhinorrhoea), fever, chills, headache, anosmia or ageusia, muscle mass pain, joint ache, diarrhoea, nausea, vomiting, loss of hunger or fatigue, as reported from the participant was defined as 1 dps. Severity, independent of being infected by SARS-CoV-2 or not, was defined based on self-reported medical symptoms, consultation of a medical professional and becoming hospitalized. Instances with any medical symptoms other than dyspnea.