Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19).
Jeroen J A van KampenDavid A M C van de VijverPieter L A FraaijBart L HaagmansMart M LamersNisreen M A OkbaJohannes P C van den AkkerHenrik EndemanDiederik A M P J GommersJan J CornelissenRogier A S HoekMenno M van der EerdenDennis A HesselinkHerold J MetselaarAnnelies VerbonJurriaan E M de SteenwinkelGeorgina I AronEric C M van GorpSander van BoheemenJolanda C VoermansCharles A B BoucherRichard MolenkampMarion P G KoopmansCorine H Geurts van KesselAnnemiek A van der EijkPublished in: Nature communications (2021)
Key questions in COVID-19 are the duration and determinants of infectious virus shedding. Here, we report that infectious virus shedding is detected by virus cultures in 23 of the 129 patients (17.8%) hospitalized with COVID-19. The median duration of shedding infectious virus is 8 days post onset of symptoms (IQR 5-11) and drops below 5% after 15.2 days post onset of symptoms (95% confidence interval (CI) 13.4-17.2). Multivariate analyses identify viral loads above 7 log10 RNA copies/mL (odds ratio [OR] of 14.7 (CI 3.57-58.1; p < 0.001) as independently associated with isolation of infectious SARS-CoV-2 from the respiratory tract. A serum neutralizing antibody titre of at least 1:20 (OR of 0.01 (CI 0.003-0.08; p < 0.001) is independently associated with non-infectious SARS-CoV-2. We conclude that quantitative viral RNA load assays and serological assays could be used in test-based strategies to discontinue or de-escalate infection prevention and control precautions.