Duration of infectious virus shedding in patients with severe coronavirus disease 2019 who required mechanical ventilation

Abstract

Background: Approximately 5% of patients with coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 develop severe COVID-19. Severe COVID-19 requires respiratory management with mechanical ventilation and an extended period of treatment. Prolonged infectious virus shedding is a concern in severe COVID-19 cases, but few reports have examined the duration of infectious virus shedding. Therefore, we investigated the duration of infectious virus shedding in patients transferred to Hiroshima University Hospital with severe COVID-19 requiring mechanical ventilation. Methods: Nasopharyngeal swab specimens were collected and analyzed using both viral culture and reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) tests between December 2020 and February 2021. Results: Of the 23 patients tested, the proportions of those with positive test results at first specimen collection (the median number of days to first specimen collection after symptom onset was 10) on RT-qPCR and viral culture tests were 95⋅7% and 30⋅4%, respectively. All six patients with positive viral culture test results who were followed-up tested negative 24 days after symptom onset but remained positive on RT-qPCR. Viral loads based on PCR testing did not decrease over time, but those determined via culture tests decreased over time. The longest negative conversion time was observed in a dialysis patient on immunosuppressive drugs. Conclusions: This study indicated that patients with severe COVID-19 remain culture positive for ≥ 10 days after symptom onset. Additionally, immunosuppressed patients with severe COVID-19 could consider isolation for ≥ 20 days.

Prolonged persistence of canine distemper virus RNA, and virus isolation in naturally infected shelter dogs

“…Viral RNA excretion for MV may remain detectable based on RT-PCR testing for long periods of time, even after viable virus is no longer detected [23,26]. A similar is reported with SARS-CoV-2 in people where COVID-19 patients stop shedding infectious virus early in the course of the disease but remain positive on RT-PCR testing for a much longer period [27,28].…”

Analysis of the Factors That Affect the Detection Duration of SARS-CoV-2 in Loop Mediated Isothermal Amplification among COVID-19 Inpatients

“…In addition, it was suggested that viral clearance may be reduced and viruses may be shed for a longer period in patients with severe disease (23). Reports of severe and immunocompromised patients in Japan suggested that infectious viruses may be shed for a period of nearly 3 weeks (24). The CDC recommends an isolation duration of about 3 weeks for severe COVID-19 patients (15).…”

Duration of infectious viral shedding in patients with mild to moderate COVID-19 treated with REGN-CoV2

“…Vero cells expressing TMPRSS2 (VeroE6/TMPRSS2 cells, JCRB1819; JCRB Cell Bank, Japan) were used to culture SARS-CoV-2. The viral culture method used was similar to that described previously [ 10 ]. The cells were observed for 5 days to check for cytopathic effects (CPEs), and the infection titer was determined using the TCID 50 method.…”

“…RT-qPCR was performed as described previously [ 10 ]. Nucleic acid extraction of SARS-CoV-2 was performed using the Maxwell® Viral Total Nucleic Acid Purification Kit (Promega Corporation, Madison, WI, USA), and RT-qPCR was performed using the One Step PrimeScript™ III RT-qPCR mix (Takara Bio Inc., Japan).…”