The presence of serum anti‐SARS‐CoV‐2 IgA appears to protect primary health care workers from COVID‐19

The patterns of humoral and cellular responses to SARS‐CoV‐2 were studied in Swedish primary health care workers (n = 156) for 6 months during the Covid‐19 pandemic. Serum IgA and IgG to SARS‐CoV‐2, T‐cell proliferation and cytokine secretion, demographic and clinical data, PCR‐verified infection, and self‐reported symptoms were monitored. The multivariate method OPLS‐DA was used to identify immune response patterns coupled to protection from Covid‐19. Contracting Covid‐19 was associated with SARS‐CoV‐2‐specific neutralizing serum IgG, T cell, IFN‐γ, and granzyme B responses to SARS‐CoV‐2, self‐reported typical Covid‐19 symptoms, male sex, higher BMI, and hypertension. Not contracting Covid‐19 was associated with female sex, IgA‐dominated, or no antibody responses to SARS‐CoV‐2, airborne allergy, and smoking. The IgG‐responders had SARS‐CoV‐2‐specific T‐cell responses including a cytotoxic CD4+ T‐cell population expressing CD25, CD38, CD69, CD194, CD279, CTLA‐4, and granzyme B. IgA‐responders with no IgG response to SARS‐CoV‐2 constituted 10% of the study population. The IgA responses were partially neutralizing and only seen in individuals who did not succumb to Covid‐19. To conclude, serum IgG‐dominated responses correlated with T‐cell responses to SARS‐CoV‐2 and PCR‐confirmed Covid‐19, whereas IgA‐dominated responses correlated with not contracting the infection. Immunity development to SARS‐CoV‐2 was monitored in primary care health workers for 6 months. IgA‐only responders appeared to be protected from contracting Covid‐19. Being an IgG responder was associated with contracting Covid‐19 and SARS‐CoV‐2‐specific T‐cell responsiveness. There was scant evidence of T‐cell responses to SARS‐CoV‐2 among seronegative individuals.