Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19)
Jeroen J A van Kampen, David A M C van de Vijver, Pieter L A Fraaij, Bart L Haagmans, Mart M Lamers, Nisreen Okba, Johannes P C van den Akker, Henrik Endeman, Diederik A M P J Gommers, Jan J Cornelissen, Rogier A S Hoek, Menno M van der Eerden, Dennis A Hesselink, Herold J Metselaar, Annelies Verbon, Jurriaan E M de Steenwinkel, Georgina I Aron, Eric C M van Gorp, Sander van Boheemen, Jolanda C Voermans, Charles A B Boucher, Richard Molenkamp, Marion P G Koopmans, Corine Geurtsvankessel, Annemiek A van der Eijk, Jeroen J A van Kampen, David A M C van de Vijver, Pieter L A Fraaij, Bart L Haagmans, Mart M Lamers, Nisreen Okba, Johannes P C van den Akker, Henrik Endeman, Diederik A M P J Gommers, Jan J Cornelissen, Rogier A S Hoek, Menno M van der Eerden, Dennis A Hesselink, Herold J Metselaar, Annelies Verbon, Jurriaan E M de Steenwinkel, Georgina I Aron, Eric C M van Gorp, Sander van Boheemen, Jolanda C Voermans, Charles A B Boucher, Richard Molenkamp, Marion P G Koopmans, Corine Geurtsvankessel, Annemiek A van der Eijk
Abstract
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.
Conflict of interest statement
The authors declare no competing interests.
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