Joint Investigation of 2-Month Post-diagnosis IgG Antibody Levels and Psychological Measures for Assessing Longer Term Multi-Faceted Recovery Among COVID-19 Cases in Northern Cyprus Barin, Burc; Yoldascan, Banu Elcin; Savaskan, Fatma; Ozbalikci, Goncagul; Karaderi, Tugce; Çakal, Hüseyin Published in: Frontiers in Public Health DOI: 10.3389/fpubh.2020.590096 Publication date: 2021 Document version Publisher's PDF, also known as Version of record Document license: CC BY Citation for published version (APA): Barin, B., Yoldascan, B. E., Savaskan, F., Ozbalikci, G., Karaderi, T., & Çakal, H. (2021). Joint Investigation of 2- Month Post-diagnosis IgG Antibody Levels and Psychological Measures for Assessing Longer Term Multi- Faceted Recovery Among COVID-19 Cases in Northern Cyprus. Frontiers in Public Health, 8, [590096]. https://doi.org/10.3389/fpubh.2020.590096 Download date: 02. okt.. 2021 BRIEF RESEARCH REPORT published: 02 February 2021 doi: 10.3389/fpubh.2020.590096 Joint Investigation of 2-Month Post-diagnosis IgG Antibody Levels and Psychological Measures for Assessing Longer Term Multi-Faceted Recovery Among COVID-19 Cases in Northern Cyprus Burc Barin 1*, Banu Elcin Yoldascan 2, Fatma Savaskan 3, Goncagul Ozbalikci 4, Tugce Karaderi 5,6,7† and Hüseyin Çakal 8† 1 Vaccines and Infectious Diseases Therapeutic Research Area, The Emmes Company, Rockville, MD, United States, 2 Faculty of Medicine, Cyprus International University, Nicosia, Cyprus, 3 Department of Infection Control, Burhan Nalbantoglu State Hospital, Nicosia, Cyprus, 4 Microbiology Laboratory, Burhan Nalbantoglu State Hospital, Nicosia, Cyprus, 5 Department of Disease Systems Biology, Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 6 Edited by: Copenhagen, Denmark, Faculty of Medical and Health Sciences, Center for Health Data Science, University of 7 Jeanne Marie Fair, Copenhagen, Copenhagen, Denmark, Disease Systems Biology Program, Faculty of Medical and Health Sciences, Novo 8 Los Alamos National Laboratory Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark, School of Psychology, (DOE), United States Keele University, Newcastle-under-Lyme, United Kingdom Reviewed by: Kenneth Yeh, Following the outbreak of COVID-19, multidisciplinary research focusing on the long-term MRIGlobal, United States Antonietta Lillo, effects of the COVID-19 infection and the complete recovery is still scarce. With Los Alamos National Laboratory regards to long-term consequences, biomarkers of physiological effects as well (DOE), United States as the psychological experiences are of significant importance for comprehensively *Correspondence: understanding the complete COVID-19 recovery. The present research surveys the Burc Barin [email protected] IgG antibody titers and the impact of COVID-19 as a traumatic experience in the aftermath of the active infection period, around 2 months after diagnosis, in a subset †These authors share senior authorship of COVID-19 patients from the first wave (March-April 2020) of the outbreak in Northern Cyprus. Associations of antibody titers and psychological survey measures with baseline Specialty section: characteristics and disease severity were explored, and correlations among various This article was submitted to Infectious Diseases - Surveillance, measures were evaluated. Of the 47 serology tests conducted for presence of IgG Prevention and Treatment, antibodies, 39 (83%) were positive. We identified trends demonstrating individuals a section of the journal experiencing severe or critical COVID-19 disease and/or those with comorbidities Frontiers in Public Health are more heavily impacted both physiologically and mentally, with higher IgG titers Received: 31 July 2020 Accepted: 06 November 2020 and negative psychological experience compared to those with milder disease and Published: 02 February 2021 without comorbidities. We also observed that more than half of the COVID-19 cases Citation: had negative psychological experiences, being subjected to discrimination and verbal Barin B, Yoldascan BE, Savaskan F, Ozbalikci G, Karaderi T and Çakal H harassment/insult, by family/friends. In summary, as the first study co-evaluating immune (2021) Joint Investigation of 2-Month response together with mental status in COVID-19, our findings suggest that further Post-diagnosis IgG Antibody Levels multidisciplinary research in larger sample populations as well as community intervention and Psychological Measures for Assessing Longer Term Multi-Faceted plans are needed to holistically address the physiological and psychological effects of Recovery Among COVID-19 Cases in COVID-19 among the cases. Northern Cyprus. Front. Public Health 8:590096. Keywords: COVID-19, SARS-CoV-2, recovery, immune response, antibody, psychological impact, stigma, doi: 10.3389/fpubh.2020.590096 long COVID Frontiers in Public Health | www.frontiersin.org 1 February 2021 | Volume 8 | Article 590096 Barin et al. COVID-19: Physiological and Psychological Recovery INTRODUCTION accidents and the size of the population. More specifically, while smaller nations might appear to have the upper hand in rapid Coronavirus disease of 2019 (COVID-19), resulting from SARS- enforcement of measures, contextual factors such as the increased CoV-2 infection, was declared a pandemic by the World connectivity of the individuals in smaller societies, or negative Health Organization on 11 March 2020. As of 29 July 2020, collective experiences of war and famine in the past might more than 16,000,000 COVID-19 cases were identified, and increase the prevalence of negative coping behaviors and stigma more than 650,000 deaths were reported due to the disease induced depression (9). (1). Although the scientific community has responded rapidly A particular case in point is Northern Cyprus, governed by a to detect the transmission mechanisms and develop vaccines, state that remains internationally unrecognized, and hence, not multidisciplinary research focusing on the long-term effects of included in the global epidemiological COVID-19 statistics. In the COVID-19 infection is still scarce, and not much is known the first wave of the COVID-19 outbreak in Northern Cyprus, on how the human body responds to COVID-19 infection, 108 cases were diagnosed between 10 March and 16 April both biologically and psychologically during the “longer term 2020. The authorities responded promptly and lockdown was recovery” period after discharge from the hospital/isolation. imposed on March 11 (9) effectively halting education and With regards to long-term effects, biomarkers of physiological government offices, and all other services except those considered effects as well as the psychological experiences are of significant essential. In addition to the global concern over the pandemic, importance for a comprehensive understanding of the COVID- the small community setting in Northern Cyprus (an estimated 19 recovery period (2). COVID-19 as a life-threatening infection total population of around 400,000) with a history of war and can act as an acute stressor (3) and stress can have a down- trauma (10) further caused intensified anxiety and fear in an regulatory effect on the immune system (4). The present research already sensitive population. Panic engulfed the small nation surveys the IgG antibody titers and the impact of COVID-19 as and there was widespread stigma toward those who tested a traumatic experience both during and in the aftermath of the positive or considered high-risk for transmitting the disease, active infection period. i.e. Turkish Cypriots living abroad, who were brought home There is insufficient information on the immune response to and quarantined (11). Videos of individuals under duress as COVID-19 (e.g., prevalence of different antibodies against the a result of being quarantined were widely circulated in the infection over time and development of long-term immunity). It social media, and there were news of occasional small-scale is essential to better understand the timeline of immune response protests in neighborhoods where quarantine hotels were chosen including the appearance of immunoglobulin M (IgM) and due to the perceived infection threat (12). Similarly, those who immunoglobulin G (IgG) antibodies, their lifespan and whether were tested positive recounted psychological trauma as their they are protective, at least partially, against a second infection. names made public and have been targeted (13). Therefore, Preliminary research shows that detectable IgG antibodies there are sufficient grounds to assume that in addition to the generally start appearing after the 1st week after symptom physiological impact of the disease, those who tested positive onset, reach a peak around 2–3 weeks, and stay at detectable for the COVID-19 have also experienced psychological distress blood levels at least for a duration of 2–3 months even in during and after the active infection period. In fact, in an milder cases, similar to previous observations in other SARS earlier study conducted in Wuhan (China), the prevalence infections (5–7). Moreover, the psychological effects of having of significant post-traumatic stress symptoms associated with the infection are also complex. The potential life-threatening COVID-19 was estimated as 96.2% among clinically stable impact of having severe COVID-19, the overall disease burden, COVID-19 cases at discharge from quarantine (14). Taken along with many unknowns about its short- and long-term effects together, these observations