SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients

Zou, Lirong; Ruan, Feng; Huang, Mingxing; Liang, Lijun; Huang, Huitao; Hong, Zhongsi; Jian-xiang, YU; Kang, Min; Song, Yan; Xia, Jinyu; Guo, Qianfang; Song, Tie; He, Jianfeng; Yen, Hui-Ling; Peiris, Malik; Wu, Jie

doi:10.1056/nejmc2001737

Cited by 4,686 publications

(5,197 citation statements)

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“…Third, the estimated duration of viral shedding is limited by the frequency of respiratory specimen collection, lack of quantitative viral RNA detection, and relatively low positive rate of SARS-CoV-2 RNA detection in throatswabs. 37 Fourth, by excluding patients still in hospital as of Jan 31, 2020, and thus relatively more severe disease at an earlier stage, the case fatality ratio in our study cannot reflect the true mortality of COVID-19. Last but not least, interpretation of our findings might be limited by the sample size.…”

Section: Discussionmentioning

confidence: 71%

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

et al. 2020

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Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. MethodsIn this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratoryconfirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients).Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 µg/mL (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days.Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 µg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.

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Section: Discussionmentioning

confidence: 71%

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

et al. 2020

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“…Notably, hospital-associated transmission of the COVID-19 to health-care workers and hospitalized patients has been reported [3]. Furthermore, Zou et al revealed that similar viral loads are seen in asymptomatic and symptomatic patients, indicating the transmission potential of asymptomatic patients [4]. Herein, we report a patient who presented to an outpatient clinic of Kaohsiung Chang Gung Memorial Hospital (KCGMH), and whom two days later, was confirmed to have COVID-19 infection.…”

Section: Effective Strategies To Prevent Coronavirus Disease-2019 (Comentioning

confidence: 73%

Effective strategies to prevent coronavirus disease-2019 (COVID-19) outbreak in hospital

Lee

Wang

Lin

et al. 2020

Journal of Hospital Infection

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“…SARS-CoV-2 viral load would also linked to treatment response, disease severity and progression. 8 The association of SARS-CoV-2 genotypes and viral load with SARS-CoV-2 reactivation will be an important question to address. In our study, all the patients received antiviral therapy (Oseltamivir or Arbidol).…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation

Pan

et al. 2020

Journal of Infection

335

346

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s u m m a r yObjectives: Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were based on information from the general population. However, limited data was available for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reactivation. This study aimed to evaluate the clinical characteristics of the SARS-CoV-2 reactivation. Methods: Clinical records, laboratory results, and chest CT scans were retrospectively reviewed for 55 patients with laboratory-confirmed COVID-19 pneumonia (i.e., with throat swab samples that were positive for SARS-CoV-2) who were admitted to

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SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients

Cited by 4,686 publications

References 4 publications

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Effective strategies to prevent coronavirus disease-2019 (COVID-19) outbreak in hospital

Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation

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