Prolonged incubation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a patient on rituximab therapy

Koff, Alan; Laurent-Rolle, Maudry; Hsu, Jack Chun-Chieh; Malinis, Maricar

doi:10.1017/ice.2020.1239

Cited by 19 publications

(11 citation statements)

References 11 publications

(19 reference statements)

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“…However, outliers have been reported, for example, in immunodeficient individuals or the elderly. 76,77 Likewise, the mean duration of infectiousness post-symptom onset with the model's default parameters lies within the range of 2.8-11.5 days, which is well supported by current knowledge (compare Figure 1C 70,76 Therefore, in the setting of severe disease or immunocompromise, de-isolation may be approached differently, for example, conditioned on a negative PCR test. In addition to these patient-specific differences, a number of other factors can contribute to apparent heterogeneities observed in the analyzed studies (Figure 1C).…”

Section: Discussionsupporting

confidence: 74%

An intra-host SARS-CoV-2 dynamics model to assess testing and quarantine strategies for incoming travelers, contact management, and de-isolation

Toorn

Bourquain

et al. 2021

Patterns

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Non-pharmaceutical interventions (NPIs) remain decisive tools to contain SARS-CoV-2. Strategies that combine NPIs with testing may improve efficacy and shorten quarantine durations. We develop a stochastic within-host model of SARS-CoV-2 that captures temporal changes in test sensitivities, incubation- and infectious periods. We use the model to simulate relative transmission risk for (i) isolation of symptomatic individuals, (ii) contact person management and (iii) quarantine of incoming travelers. We estimated that testing travelers at entry reduces transmission risks to 21.3% ([20.7, 23.9], PCR) and 27.9% ([27.1, 31.1], rapid diagnostic tests; RDT), compared to unrestricted entry. We calculated that 4 (PCR) vs. 5 (RDT) days pre-test quarantine are non-inferior to a 10 days quarantine for incoming travelers and that 8 (PCR) vs. 10 (RDT) days of pre-test quarantine are non-inferior to 14 days post-exposure quarantine. De-isolation of infected individuals 13 days after symptom onset may reduce the transmission risk to <0.2% [<0.01, 6.0].

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Section: Discussionsupporting

confidence: 74%

An intra-host SARS-CoV-2 dynamics model to assess testing and quarantine strategies for incoming travelers, contact management, and de-isolation

Toorn

Bourquain

et al. 2021

Patterns

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“…Yasuda et al described a case of patient with focal lymphoma after recent rituximab treatment that did not develop SARS-CoV-2 antibodies and died due to persistent pneumonia (30). Rituximab can also prolong incubation period of SARS-CoV-2 infection (>21 days), which could facilitate spreading of infection in a population (31). On the other hand there are data showing that the mortality rate of patients with COVID-19 treated with rituximab maintenance therapy after remission in follicular lymphoma is lower than when combined with chemotherapy (10): 31% vs 47%.…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy During Active SARS-CoV2 Infection: A Case Report and Review of the Literature

et al. 2021

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COVID-19 has become the biggest public health problem and one of the most important causes of death in many countries in the world. SARS-CoV-2 infection is most likely to be fatal in elderly patients with concomitant diseases. In this article we present two cases of asymptomatic SARS-CoV-2-positive patients suffering from cancer who were treated with chemotherapy. The first case, a patient with primary mediastinal B-cell lymphoma, shows that confirmed SARS-CoV-2 infection does not have to be a contraindication to chemotherapy. We describe the course of disease and discuss doubts related to the choice of chemotherapy regimen. The second patient was a male with metastatic sigmoid cancer treated with FOLFOX4 as first-line palliative chemotherapy. This case draws attention to asymptomatic SARS-CoV-2 carriers who underwent chemotherapy. Our patient was safely treated with chemotherapy without long break caused by viral infection. It should be remembered that there are asymptomatic carriers among cancer patients and that they may spread infection to others. On the other hand, delaying chemotherapy can cause rapid disease progression and reduce overall survival of our patients.

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“…The models' default parameters capture typical mean incubation periods [5.6-8. [63][64][65] ]. However, outliers have been reported, for example in immunodeficient individuals or the elderly 66,67 . Likewise, the mean duration of infectiousness post symptom onset with the models' default parameters lies within the range of 2.8 to 11.5 days, which is well supported by current knowledge (compare Fig.2) [Singanayagam et al, median 4 days; van Kampen et al, median 8 days; Arons et al ,6-9 days; Wölfel et al, <8 days; COVID-19 Investigation Team, < 9 days] 55,56,[68][69][70] .…”

Section: Discussionmentioning

confidence: 99%

“…We have assumed, for our model, that infectiousness decreases sharply due to both viral decay and virus neutralization. Of note, patients with severe or critical illness may shed infectious virus considerably longer 71 [ van Kampen et al ., up to 20 days; Jeong et al ., up to 15 days; Xiao et al ., 18 days 56,60,72 ] as may immunocompromised individuals [ Koff et al ., 20 days; Choi et al ., 143 days 62,66 ]. Therefore, in the setting of severe disease or immunocompromise, de-isolation may be approached differently, for example, conditioned on a negative PCR test.…”

Section: Discussionmentioning

confidence: 99%

COVIDStrategyCalculator: A software to assess testing- and quarantine strategies for incoming travelers, contact person management and de-isolation

Toorn

Bourquain

et al. 2020

Preprint

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In early 2020 COVID-19 turned into a global pandemic. Non-pharmaceutical interventions (NPIs), including the isolation of infected individuals, tracing and quarantine of exposed individuals are decisive tools to prevent onwards transmission and curb fatalities. Strategies that combine NPIs with SARS-CoV-2 testing may help to shorten quarantine durations while being non-inferior with respect to infection prevention. Thus, combined strategies can help reducing the socio-economic burden of SARS-CoV-2 and increase public acceptance.We developed a software that enables policy makers to calculate the reduction in transmissibility through quarantine or isolation in combination with arbitrary testing strategies. The user chooses between three different modi [(i) isolation of infected individuals, (ii) management of potentially infected contacts and (iii) quarantine of incoming travelers], while having flexibility in customizing testing strategies and model parameters. The software enables decision makers to tailor calculations specifically to their questions and perform an assessment ‘on the fly’, based on current evidence on infection dynamics.Underneath, we analytically solve a stochastic transit compartment model of the infection time course, which captures temporal changes in test sensitivities, incubation- and infectious periods, as well as times to symptom onset using its default parameters.Using default parameters, we estimated that testing travelers at the point of entry reduces the risk about 4.69 (4.19,4.83) fold for PCR vs. 3.59 (3.22, 3.69) fold for rapid diagnostic tests (RDT, 87% relative sensitivity) when combined with symptom screening. In comparison to 14 days of pure quarantine, 8 (PCR) vs. 10 (RDT) days of pre-test quarantine would be noninferior for incoming travelers as well as for contact person management. De-isolation of infected individuals 11 days after symptom onset reduces the risk by >99fold (7.68,>1012). This tool is freely available from: https://github.com/CovidStrategyCalculator/CovidStrategyCalculator

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Prolonged incubation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a patient on rituximab therapy

Cited by 19 publications

References 11 publications

An intra-host SARS-CoV-2 dynamics model to assess testing and quarantine strategies for incoming travelers, contact management, and de-isolation

An intra-host SARS-CoV-2 dynamics model to assess testing and quarantine strategies for incoming travelers, contact management, and de-isolation

Chemotherapy During Active SARS-CoV2 Infection: A Case Report and Review of the Literature

COVIDStrategyCalculator: A software to assess testing- and quarantine strategies for incoming travelers, contact person management and de-isolation

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