SARS-CoV-2 shedding and infectivity

Atkinson, Barry; Petersen, Eskild

doi:10.1016/s0140-6736(20)30868-0

Cited by 135 publications

(137 citation statements)

References 8 publications

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“…21 RT-PCR is unable to differentiate between an infectious virus and noninfectious RNA. 22 In patients with clinical improvement who are completely asymptomatic, 23 a postnegative positive RT-PCR test result does not necessarily reflect reinfection or viral carriage. 24 Evidence on SARS-CoV-2 infection and COVID-19 increases each day, and new guidelines about the recovery criteria will continue to change.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for a New Positive Nasopharyngeal Swab Among Patients Recovered From COVID-19

Landi

Carfì

Benvenuto

et al. 2021

American Journal of Preventive Medicine

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on behalf of Gemelli Against COVID-19 Post-Acute Care Team Introduction: As an emerging infectious disease, the clinical and virologic course of COVID-19 requires better investigation. The aim of this study is to identify the potential risk factors associated with persistent positive nasopharyngeal swab real-time reverse transcription-polymerase chain reaction tests in a large sample of patients who recovered from COVID-19. Methods: After the acute phase of SARS-CoV-2 epidemic infection, the Fondazione Policlinico A. Gemelli IRCSS of Rome established a post-acute care service for patients discharged from the hospital and recovered from COVID-19. Between April 21 and May 21, 2020, a total of 137 individuals who officially recovered from COVID-19 were enrolled in this study. All patients were tested for the SARS-CoV-2 virus with nucleic acid RT-PCR tests. Analysis was conducted in June 2020. Results: Of the 131 patients who repeated the nasopharyngeal swab, 22 patients (16.7%) tested positive again. Some symptoms such as fatigue (51%), dyspnea (44%), and coughing (17%) were still present in a significant percentage of the patients, with no difference between patients with a negative test and those who tested positive. The likelihood of testing positive for SARS-CoV-2 infection was significantly higher among participants with persistent sore throat (prevalence ratio=6.50, 95% CI=1.38, 30.6) and symptoms of rhinitis (prevalence ratio=3.72, 95% CI=1.10, 12.5). Conclusions: This study is the first to provide a given rate of patients (16.7%) who test positive on RT-PCR test for SARS-CoV-2 nucleic acid after recovering from COVID-19. These findings suggest that a significant proportion of patients who have recovered from COVID-19 still could be potential carriers of the virus. In particular, if patients continue to have symptoms related to COVID-19, such as sore throat and rhinitis, it is reasonable to be cautious by avoiding close contact, wearing a face mask, and possibly repeating a nasopharyngeal swab.

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Section: Discussionmentioning

confidence: 99%

Predictive Factors for a New Positive Nasopharyngeal Swab Among Patients Recovered From COVID-19

Landi

Carfì

Benvenuto

et al. 2021

American Journal of Preventive Medicine

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“…On 22 April 2020, there were more than 23 000 cases in the Emilia-Romagna region. 16 17 Until there is information on whether patients who are clinically recovered but still swab-positive are contagious, 18 and given the low sensitivity of viral tests, [19][20][21] patients must remain isolated until complete viral clearance is achieved as confirmed by RT-PCR for SARS-CoV-2 on two consecutive negative swabs. 22 As this will result in an enormous increase in the workload of national healthcare services, knowing as much as possible about the distribution of clearance timing and its determinants is fundamental to optimising the number of tests necessary to obtain viral clearance confirmation and thus to reducing the amount of time in unnecessary isolation of those patients who are clinically recovered.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Temporal profile and determinants of viral shedding and of viral clearance confirmation on nasopharyngeal swabs from SARS-CoV-2-positive subjects: a population-based prospective cohort study in Reggio Emilia, Italy.

et al. 2020

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Objectives To determine the timing of viral clearance (first negative RT-PCR on nasopharyngeal swab) and the probability of viral clearance confirmation (two consecutive negative swabs) in COVID-19 patients and to identify related determinants. Design Population-based prospective cohort study on archive data. Setting Preventive services and hospital care in the Reggio Emilia province, northern Italy. Participants All 1162 subjects testing positive to RT-PCR on nasopharyngeal swabs and diagnosed with COVID-19 in the Reggio Emilia province with at least 30 days of follow-up by 22 April 2020. Main outcome measures Median times from diagnosis and from symptom onset to viral clearance with IQR assessed using the Kaplan-Meier estimator, stratified by included characteristics. The probability of viral clearance confirmation, stratified by time from diagnosis and putative determinants assessed using a multivariate logistic regression model. Results Viral clearance was achieved by 60.6% (704/1162) of patients, with a median time of 30 days from diagnosis (IQR 23-40) and 36 days from symptom onset (IQR 28-45). Of those negative and retested, 78.7% (436/554) had viral clearance confirmation, suggesting one in five false negative tests. The time from symptom onset to viral clearance slightly increased with age, from 35 (IQR 26-44) days under age 50 to 38 (IQR 28-44) in over age 80, and with disease severity, from 33 (IQR 25-41) days in non-hospitalised subjects to 38 (IQR 30-47) days in hospitalised patients. The probability of confirmed viral clearance reached 86.8% after 34 days from symptom onset and increased with time, even when adjusting for age and sex (OR 1.16 95% CI 1.06 to 1.26 per day from diagnosis). Conclusions Postponing follow-up testing of clinically recovered COVID-19 patients could increase the efficiency and performance of testing protocols. Understanding viral shedding duration also has implications for containment measures of paucisymptomatic subjects. ► This is one of the few studies providing populationbased evidence on the duration of viral shedding in SARS-CoV-2-positive patients. ► All patients testing positive for SARS-CoV-2 in the province of Reggio Emilia with a minimum follow-up of 30 days up to 22 April 2020 were included. ► The median time from symptom onset and from diagnosis to viral clearance (ie, first negative RT-PCR assay on nasopharyngeal swab) was assessed and stratified by putative determinants. ► The assessment of time to viral clearance was limited by the testing intervals, which in our study reflect the real-world practice. ► The probability of confirmation of viral clearance (ie, two consecutive negative swabs) was also reported overall and stratified by time from diagnosis and symptom onset.

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“…10 Many authors support the thesis that positive RT-PCR results can occur with the detection of small fragments of the virus on the nasal mucosa. 11 In the absence of viral cultures assay able to identify viral replication and hence, virus infectivity, all containment measures to avert virus spreading are necessary for the dialysis facilities. A profound reorganization of the places used to perform renal replacement therapy must ensure the correct isolation of infected patients.…”

Section: Discussionmentioning

confidence: 99%

Long‐term effects of COVID‐19 in a patient on maintenance dialysis

Perrone

Fontana

Mori

et al. 2020

Hemodialysis International

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Coronavirus infectious disease (COVID-19) is a novel respiratory infection highly associated with severe complications in elderly subjects affected by cardiovascular disease. Patients on maintenance dialysis are exceptionally vulnerable because most of them are old and have multiple comorbidities. We report the complex clinical course of SARS-CoV-2 infection in a patient on maintenance dialysis who presented with fever and lung edema. After 41 days from the primary infection, the clinically recovered patient experienced symptomatic reactivation of SARS-COV-2 infection documented by positive polymerase chain reaction (PCR) result on nasal/oropharyngeal swab along with immunoglobulin M seroconversion. The recurrence of PCR positivity forced us to perform hemodialysis in a separate isolation room for a prolonged period of time. Close monitoring of previously infected patients and restructuring of dialysis facilities are necessary to avoid new outbreaks of this concerning disease.

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SARS-CoV-2 shedding and infectivity

Abstract: still positive for SARS-CoV-2 RNA. Further effort is urgently needed to evaluate the basic reproductive number in these patients.We declare no competing interests.

Cited by 135 publications

References 8 publications

Predictive Factors for a New Positive Nasopharyngeal Swab Among Patients Recovered From COVID-19

Predictive Factors for a New Positive Nasopharyngeal Swab Among Patients Recovered From COVID-19

Temporal profile and determinants of viral shedding and of viral clearance confirmation on nasopharyngeal swabs from SARS-CoV-2-positive subjects: a population-based prospective cohort study in Reggio Emilia, Italy.

Long‐term effects of COVID‐19 in a patient on maintenance dialysis

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