Clin Infect Dis . Duration of replication-competent SARS-CoV-2 shedding among patients with severe or critical coronavirus disease 2019 (COVID-19)

[tetano]

Clin Infect Dis


. 2022 May 24;ciac405.
doi: 10.1093/cid/ciac405. Online ahead of print.
Duration of replication-competent SARS-CoV-2 shedding among patients with severe or critical coronavirus disease 2019 (COVID-19)


Do Young Kim ¹ , Michael Y Lin ² , Cheryl Jennings ³ , Haiying Li ⁴ , Jae Hyung Jung ⁵ , Nicholas M Moore ⁶ , Isaac Ghinai ⁷ , Stephanie R Black ⁷ , Daniel J Zaccaro ⁸ , John Brofman ⁹ , Mary K Hayden ² , CDC Prevention Epicenter Program



Affiliations

• PMID: 35607802
• DOI: 10.1093/cid/ciac405

Abstract

Background: Patterns of shedding replication-competent SARS-CoV-2 in severe or critical COVID-19 are not well-characterized. We investigated the duration of replication-competent SARS-CoV-2 shedding in upper and lower airway specimens from patients with severe or critical COVID-19.
Methods: We enrolled patients with active or recent severe or critical COVID-19 who were admitted to a tertiary care hospital intensive care unit (ICU) or long-term acute care hospital (LTACH) because of COVID-19. Respiratory specimens were collected at predefined intervals and tested for SARS-CoV-2 using virus culture and RT-qPCR. Clinical and epidemiologic metadata were reviewed.
Results: We collected 529 respiratory specimens from 78 patients. Replication-competent virus was detected in 4 of 11 (36.3%) immunocompromised patients up to 45 days after symptom onset, and in 1 of 67 (14.9%) immunocompetent patients 10 days after symptom onset (P = 0.001). All culture-positive patients were in the ICU cohort and had persistent or recurrent symptoms of COVID-19. Median time from symptom onset to first specimen collection was 15 days (range, 6-45) for ICU patients and 58.5 days (range, 34-139) for LTACH patients. SARS-CoV-2 RNA was detected in 40 of 50 (80%) ICU patients and 7 of 28 (25%) LTACH patients.
Conclusions: Immunocompromise and persistent or recurrent symptoms were associated with shedding of replication-competent SARS-CoV-2, supporting the need for improving respiratory symptoms in addition to time as criteria for discontinuation of transmission-based precautions. Our results suggest that the period of potential infectiousness among immunocompetent patients with severe or critical COVID-19 may be similar to that reported for patients with milder disease.

Keywords: SARS-CoV-2; intensive care; long-term acute care hospital; virus culture; virus shedding.