Persistent positivity of SARS-CoV-2 nucleic acid in asymptomatic healthcare worker: infective virion or inactive nucleic acid?

Tiwari, Lokesh; Gupta, Prakriti; Singh, Chirom Amit; Singh, Prabhat Kumar

doi:10.1136/bcr-2020-241087

Cited by 11 publications

(11 citation statements)

References 30 publications

(27 reference statements)

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“…4 Many hospitalized patients with prolonged viral shedding may test COVID-19 positive even after resolution of symptoms and infectivity, causing an extended hospitalization. [5][6][7][8] In addition to measuring viral load, serological tests measuring antibody responses against SARS-CoV-2 are also valuable diagnostic tools. SARS-CoV-2-specific antibodies against the receptor binding domain (RBD), nucleocapsid (N), and spike (S) antigens vary over time, correspond to disease severity, and peak 1 to 2 months after symptom onset.…”

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confidence: 99%

SARS‐CoV‐2 show no infectivity at later stages in a prolonged COVID‐19 patient despite positivity in RNA testing

Wan

Tang

Ritter

et al. 2021

Journal of Medical Virology

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Inpatient coronavirus disease 2019 cases present enormous costs to patients and health systems in the United States. Many hospitalized patients may continue testing COVID-19 positive even after the resolution of symptoms. Thus, a pressing concern for clinicians is the safety of discharging these asymptomatic patients if they have any remaining infectivity. This case report explores the viral viability in a patient with persistent COVID-19 over the course of a 2-month hospitalization. Positive nasopharyngeal swab samples were collected and isolated in the laboratory and analyzed by quantitative reverse-transcription polymerase chain reactions (qRT-PCR), and serology was tested for neutralizing antibodies throughout the hospitalization period. The patient experienced waning symptoms by hospital day 40 and had no viable virus growth by hospital day 41, suggesting no risk of infectivity, despite positive RT-PCR results which prolonged his hospital stay. Notably, this case showed infectivity for at least 24 days after disease onset, which is longer than the discontinuation of transmission-based precautions recommended by the Center for Disease Control and Prevention. Thus, our findings suggest that the timeline for discontinuing transmission-based precautions may need to be extended for patients with severe and prolonged COVID-19 disease. Additional large-scale

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confidence: 99%

SARS‐CoV‐2 show no infectivity at later stages in a prolonged COVID‐19 patient despite positivity in RNA testing

Wan

Tang

Ritter

et al. 2021

Journal of Medical Virology

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“…These results deserve further attention with regard to ensuring universal infection prevention precautions, irrespective of symptomatic and immunization status, and clearly confirm that our knowledge is uncertain and incomplete. Referring to considerations by Tiwari et al [ 37 ], we sum up as below: HCWs are at high risk of exposure to influenza, SARS-CoV-2 and other respiratory viruses. Undiagnosed HCWs can transmit the above viruses to patients and pose an occupational hazard to coworkers.…”

Section: Discussionmentioning

confidence: 99%

Section: Practical Implicationsmentioning

confidence: 99%

Incidence of Influenza Virus Infection among Wroclaw’s Healthcare Workers in Pre-COVID-19 2019–2020 Influenza Season Using Novel Flu SensDx Device

Jędrzejek

Mastalerz-Migas

Janicka

2022

IJERPH

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Background: Healthcare workers (HCWs) are more exposed to influenza infection, and the influenza vaccination is recommended each year, to reduce the risk of influenza infection and prevent influenza transmission. This study is a cross-sectional study and the objectives were to determine the rate of influenza virus infection among HCWs in the 2019–2020 influenza season. Methods: Between January and March 2020, a survey was carried out in 2 hospitals and 15 primary health-care settings (PHCS) in Wroclaw (Poland). The novel point-of-care testing Flu SensDx device was used, which detects the M1 protein of the influenza virus using electrochemical impedance spectroscopy from biological material (throat/nasal swabs). Results: A total of 150 samples were collected. The majority of participating HCWs by profession were 83 physicians (55.3%) and half (51.3%) of the participating HCWs worked in PHCS. Influenza vaccination coverage was 61.3% in 2019–2020 and 46.0% in the 2018–2019 season for all participants. Of the participating HCWs, 44.0% were positive tested by the Flu SensDx device. There were no statistically significant differences among the positive tested HCWs, their influenza immunization history, and the presence of symptoms of influenza-like illness (p > 0.05). Conclusion: Although the results of the present study suggest that influenza vaccination does not reduce the frequency of influenza virus detection by Flu SensDx testing in the HCWs participants, larger studies are needed to estimate the incidence of influenza virus infection among HCWs to understand the underlying mechanism and fine-tune policies aimed at reducing nosocomial infections.

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“… 3 The spectrum of COVID-19 illness varies across age groups from asymptomatic infection to life-threatening multiorgan dysfunction. 4–6 Most of the studies and meta-analyses suggest that older age, male sex and presence of comorbidities are strongly associated with severity of illness and risk of death in COVID-19 patients. 7 8 In the studies from USA and Italy, median age of hospitalised patients is reported >60 years and mortality rates of 21%–39%.…”

Section: Introductionmentioning

confidence: 99%

Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India

et al. 2022

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ObjectivesPrimary objective was to study the clinicodemographic profile of hospitalised COVID-19 patients at a tertiary-care centre in India. Secondary objective was to identify predictors of poor outcome.SettingSingle centre tertiary-care level.DesignRetrospective cohort study.ParticipantsConsecutively hospitalised adults patients with COVID-19.Primary and secondary outcome measuresPrimary outcome variable was in-hospital mortality. Covariables were known comorbidities, clinical features, vital signs at the time of admission and on days 3–5 of admission, and initial laboratory investigations.ResultsIntergroup differences were tested using χ2 or Fischer’s exact tests, Student’s t-test or Mann-Whitney U test. Predictors of mortality were evaluated using multivariate logistic regression model. Out of 4102 SARS-CoV-2 positive patients admitted during 1-year period, 3268 (79.66%) survived to discharge and 834 (20.33%) died in the hospital. Mortality rates increased with age. Death was more common among males (OR 1.51, 95% CI 1.25 to 1.81). Out of 261 cases analysed in detail, 55.1% were in mild, 32.5% in moderate and 12.2% in severe triage category. Most common clinical presentations in the subgroup were fever (73.2%), cough/coryza (65.5%) and breathlessness (54%). Hypertension (45.2%), diabetes mellitus (41.8%) and chronic kidney disease (CKD; 6.1%) were common comorbidities. Disease severity on admission (adjusted OR 12.53, 95% CI 4.92 to 31.91, p<0.01), coagulation defect (33.21, 3.85–302.1, p<0.01), CKD (5.67, 1.08–29.64, p=0.04), high urea (11.05, 3.9–31.02, p<0.01), high prothrombin time (3.91, 1.59–9.65, p<0.01) and elevated ferritin (1.02, 1.00–1.03, p=0.02) were associated with poor outcome on multivariate regression. A strong predictor of mortality was disease progression on days 3–5 of admission (adjusted OR 13.66 95% CI 3.47 to 53.68).ConclusionCOVID-19 related mortality in hospitalised adult patients at our center was similar to the developed countries. Progression in disease severity on days 3–5 of admission or days 6–13 of illness onset acts as ‘turning point’ for timely referral or treatment intensification for optimum use of resources.

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Persistent positivity of SARS-CoV-2 nucleic acid in asymptomatic healthcare worker: infective virion or inactive nucleic acid?

Cited by 11 publications

References 30 publications

SARS‐CoV‐2 show no infectivity at later stages in a prolonged COVID‐19 patient despite positivity in RNA testing

SARS‐CoV‐2 show no infectivity at later stages in a prolonged COVID‐19 patient despite positivity in RNA testing

Incidence of Influenza Virus Infection among Wroclaw’s Healthcare Workers in Pre-COVID-19 2019–2020 Influenza Season Using Novel Flu SensDx Device

Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India

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