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. 2020 Dec;81(6):923-930.
doi: 10.1016/j.jinf.2020.10.023. Epub 2020 Oct 27.

Prior presumed coronavirus infection reduces COVID-19 risk: A cohort study

Dvir Aran  1 , Daniel C Beachler  2 , Stephan Lanes  2 , J Marc Overhage  2
Affiliations

Prior presumed coronavirus infection reduces COVID-19 risk: A cohort study

Dvir Aran et al. J Infect. 2020 Dec.

Abstract

Background: Immunological cross-reactivity between common cold coronaviruses (CCC) and SARS-CoV-2 might account for the reduced incidence of COVID-19 in children. Evidence to support speculation includes in vitro evidence for humoral and cellular cross-reactivity with SARS-CoV-2 in specimens obtained before the pandemic started.

Method: We used retrospective health insurance enrollment records, claims, and laboratory results to assemble a cohort of 869,236 insured individuals who had a PCR test for SARS-CoV-2. We estimated the effects of having clinical encounters for various diagnostic categories in the year preceding the study period on the risk of a positive test result.

Findings: After adjusting for age, gender and care seeking behavior, we identified that individuals with diagnoses for common cold symptoms, including acute sinusitis, bronchitis, or pharyngitis in the preceding year had a lower risk of testing positive for SARS-CoV-2 (OR=0.76, 95%CI=0.75, 0.77). No reduction in the odds of a positive test for SARS-CoV-2 was seen in individuals under 18 years. The reduction in odds in adults remained stable for four years but was strongest in those with recent common cold symptoms.

Interpretation: While this study cannot attribute this association to cross-immunity resulting from a prior CCC infection, it is one potential explanation. Regardless of the cause, the reduction in the odds of being infected by SARS-CoV-2 among those with a recent diagnosis of common cold symptoms may have a role in shifting future COVD-19 infection patterns from endemic to episodic.

Keywords: Common cold; Covid-19; Cross reactive; SARS-Cov-2.

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Conflict of interest statement

Declaration of Competing Interest Drs. Overhage, Beachler and Lanes are employees of HealthCore Inc., a subsidiary of Anthem Inc. Dr. Aran is a consutlant for Anthem Innovation Israel. None of the authors have any competing interests.

Figures

Fig. 1
Fig. 1
Study cohort. A) Individuals that were not enrolled for 12 months prior the SARS-CoV-2 test were excluded. B) The age (left) and gender (right) distributions of individuals with positive and negative PCR tests for SARS-CoV-2 were similar. 15.1% of the individuals in the cohort were SARS-CoV-2 positive.
Fig. 2
Fig. 2
Phenotypes and diagnoses associated with a positive SARS-CoV-2 test. A) A volcano plot of the effect size of prevalent diagnostic categories on SARS-CoV-2 PCR test positivity and significance (log scale). The size of the circle is proportional to the number of individuals with the phenotype, and red circles indicate significance (p < 1e-20). -log10(p-values are capped at 100. B) A volcano plot of the effect size of prevalent ICD-10 diagnosis codes on SARS-CoV-2 PCR test positivity and significance (log scale). The size of the circle is proportional to the number of individuals with the phenotype, and red circles indicate significance (p < 1e-15).
Fig. 3
Fig. 3
Individuals with common cold symptom diagnoses. Age (A) and gender (B) distributions of 126,998 patients with acute sinusitis, acute bronchitis, or acute pharyngitis ICD-10 codes were similar in individuals with positive and negative SARS-CoV-2 PCR tests. C) The overlap of ICD-10 diagnosis codes, percentage from the cohort, and delta SARS-CoV-2 positive rate for each of the symptoms and combined, stratified by age. (D) Odds ratios for having a positive PCR test for SARS-CoV-2, stratified by age.
Fig. 5
Extended Figure 1
Age stratification. Odds ratios for having a positive PCR test for SARS-CoV-2, stratified by age groups.
Fig. 6
Extended Figure 2
Fig. 5
Extended Figure 3
Fig. 4
Fig. 4
Protective effect of common cold symptoms over time. Thirty-day moving average of the temporal association between the last date the ICD-10 diagnosis code was recorded and the PCR test for SARS-CoV-2 in 2020.
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