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

Abstract

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

Prolonged SARS-CoV-2 Positivity in Immunocompetent Patients: Virus Isolation, Genomic Integrity, and Transmission Risk

“…However, we successfully isolated infectious viruses from samples with a low estimated viral load ( C T value, >32). These data are supported by reports of infectious virus recovery from samples with C T values of 32 ( 14 , 23 ) and the previously determined C T value cutoff of 37 for virus isolation from URT specimens ( 23 ). This apparent discrepancy could be due to the differences in viral culture assays implemented which will differ in sensitivity.…”

“…van Kampen and colleagues reported low (5%) infectious virus recovery 15 days after symptom onset or longer ( 24 ). Nevertheless, the recovery of cultivable virus up to 18 and 24 days after symptom onset has been reported ( 14 , 23 ). In the present study, we achieved infectious virus recovery in 27.45% of patients after the 14th day after symptoms onset, including 6 patients with persistent SARS-CoV-2 detection by rRT-PCR for longer than 21 days.…”

“…The viral load in the upper respiratory tract (URT) of infected individuals peaks from 1 to 2 days before, to 5 days after symptom onset (DASO), decreasing over the next 1 to 3 weeks ( 5 – 7 ). Despite the detection of viral RNA by real-time reverse transcription PCR (rRT-PCR), most studies failed to demonstrate the presence of replication-competent viruses from URT samples obtained from longer than 8 to 9 days after symptom onset ( 8 , 9 ), with exceptions described in immunosuppressed and severe cases ( 10 – 14 ). Following these findings, current guidelines recommend discontinuation of isolation after 10 days of symptom onset, without testing ( 15 , 16 ).…”

Antigenic characterization of influenza and SARS-CoV-2 viruses

“…Various commercial SARS-CoV-2 pseudoviruses are also available for purchase from mybiosource.com, Takara, eEnzyme, and multiple other companies. Limitations of this platform include the need to create a separate assay to test different aspects of virus mechanisms or other proteins and potential variability between the protein functions of pseudotyped virus and wild type virus [422]. While some studies as in Case et al [421] had determined strong correlations between pseudovirus results and wild type, few studies using pseudoviruses confirm findings with wild type virus.…”

Persistence of infectious SARS‐CoV‐2 particles for up to 37 days in patients with mild COVID‐19

“… 8 , 9 , 10 , 11 Based on these findings, a common practice is to isolate COVID‐19 patients for 14 days and to discontinue the quarantine without further testing given the patient is asymptomatic for at least 48 h. There are also reports that describe infectivity for at least 24 days after disease onset in patients with severe COVID‐19 but showing no infectivity at later stages of a prolonged COVID‐19 infection despite positivity in RNA testing. 12 Hence, because of the discrepancy of this finding to the experiments aimed at isolating active virus and the current time periods for quarantine, the timeline for discontinuation of transmission‐based precautions is extensively debated.…”