Time Kinetics of Viral Clearance and Resolution of Symptoms in Novel Coronavirus Infection

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; previously called "2019-nCoV"; the virus that causes coronavirus disease [COVID-19]) has infected .1,773,000 patients and killed .111,650 people worldwide as of April 13, 2020 (1). It has been reported that a patient in Germany had high viral titers after the resolution of fever and infected two close contacts after the resolution of symptoms (2). In the wake of these cases, it is still unclear how long the patient was virus positive after the resolution of symptoms. In this study, we aimed to determine the time kinetics of viral clearance in reference to the resolution of symptoms in 16 patients treated in Beijing, China, and we show that half of the patients with COVID-19 were virus positive even after resolution of their symptoms. Cases We studied all 16 patients with confirmed COVID-19 released from the treatment center of People's Liberation Army General Hospital in Beijing, China, between January 28 and February 9, 2020. On alternate days, all patients had throat swabs collected, which were then analyzed. Patients were discharged after their recovery and confirmation of "virus-negative" status by at least two consecutive real-time PCRs (3). There was only one case of a false-negative result in our study: patient 6 had a negative test result followed by a positive detection and then two consecutive negative tests. Travel and possible exposure history were obtained from the patients and noted on their records. Epidemiologically, 10 patients visited Wuhan after the outbreak; 3 had exposure to a known infected patient; 2 came in contact with people from Wuhan; and 1 had no known exposure. The basic clinical characteristics are given in Table 1. The median age was 35.5 years (range, 3-68 yr), with 11 of 16 being male. The major symptoms in these patients were fever (14 of 16), cough (11 of 16), pharyngalgia (5 of 16), and dyspnea (2 of 16). The day of onset and resolution of these symptoms were noted. Details of symptoms are indicated in the online supplement. Ground-glass opacities were observed by computed tomography of the chest in both sides of the lungs in six patients and only in the right lung in one patient. Concentrations of C-reactive protein and procalcitonin between the first sample obtained at the time of hospitalization and the last sample obtained before discharge were comparable (Table 1). All the patients received various medical care to treat COVID-19. Fifteen patients were treated with IFN-a together with other antiviral drugs, including oseltamivir (1 of 16), lopinavir/ritonavir (11 of 16),

COVID-19 Real-Time RT-PCR: Does Positivity on Follow-up RT-PCR Always Imply Infectivity?

“…Among 16 patients with predominantly mild disease, they found that the median duration of symptoms was 8 days. They found that 8 patients remained real-time PCR positive beyond symptom resolution for a median of 2.5 days after clinical recovery (1). These findings are in congruence with the work of Young et al who reported that SARS-CoV-2 remained detectable by PCR in nasopharyngeal swabs for a median duration of 12.5 days after symptom onset.…”

Safe performance of diagnostic bronchoscopy/EBUS during the SARS‐CoV‐2 pandemic

“…27 If patients develop symptoms subsequent to a positive test, then a longer delay before bronchoscopy is needed. 28,29 Critically, we note that sensitivity of nasopharyngeal swab for COVID-19 infection has been reported at 71-83% among symptomatic patients, 30,31 and may be even lower among asymptomatic patients. Given the numerous reports regarding false-negative results for nasopharyngeal swab reverse transcriptase (RT)-PCR testing, 32,33 we recommend universal precautions, including PPE (below), be applied even in the event of a negative nasopharyngeal swab result.…”

Early Description of Coronavirus 2019 Disease in Kidney Transplant Recipients in New York

“…Current estimates are that viral shedding can occur for up to 2 weeks or more after improvement of symptoms, but there is also considerable variation (maximum observed shedding of 37 days). [7][8][9] There is also an association between severity of illness and peak viral loads, which may in turn influence the duration of subsequent viral shedding. 10 Thus, given the present uncertainty, our current clinical practice has been to delay reintroduction of these agents for up to 2 weeks after discharge, recognizing that prolonged reduction of immunosuppression increases the risk of allograft rejection.…”